End-tidal carbon dioxide in the early phase of cardiopulmonary exercise testing prior to major colorectal cancer surgery associates with postoperative outcome

Alfitian, J; Basto, J; Miestereck, J; Ismail, H; Ho, KM; Kammerer, T; Schick, V; Riedel, B; Schier, R

Author(s): Alfitian, J; Basto, J; Miestereck, J; Ismail, H; Ho, KM; Kammerer, T; Schick, V; Riedel, B; Schier, R;
Details: Publication Year 2023-06,Volume 89,Issue #6,Page 536-545
Journal Title: Minerva Anestesiologica
Publication Type: Research article
Abstract: BACKGROUND: Cardiopulmonary exercise testing (CPET) objectively informs preoperative risk stratification prior to major surgery. CPET facilities are resource intensive and therefore more cost-effective triage methods are desirable for scalability. We tested two dynamic CPET parameters (end-tidal CO<inf>2</inf> (P<inf>et</inf>CO<inf>2</inf>) and heart rate (HR)) to early phase exercise and resting diffusion capacity (DLCO) as potential point of care assessments that could be used outside of formal CPET testing facilities. METHODS: We conducted a retrospective cohort study including 84 patients who underwent CPET prior to elective major abdominal cancer surgery. Data were analyzed for P<inf>et</inf>CO<inf>2</inf> and HR in response to early phase (2 minutes) exercise as well as resting DLCO against postoperative complications and two-year survival. Complications were classified according to Clavien-Dindo classification into less severe and severe (CD>IIIb) grades. Optimal cut points for predicting outcomes were determined using the Youden Index of receiver operating characteristic (ROC) curves. Multivariate regression modeling including both logistic and Cox proportional-hazards model adjusted to age and comorbidity burden was used to analyse the association between the selected parameters and postoperative outcomes. RESULTS: P<inf>et</inf>CO<inf>2</inf>, in response to two minutes of loaded exercise was higher in survivors than in non-survivors (median (IQR) 40.0 (4.2) mmHg vs. 34.5 (5.2) mmHg, P<0.001). There was no association between chronotropic response and postoperative outcome. The optimal cut point for predicting postoperative complications and survival was 38 mmHg and 37.1 mmHg for P<inf>et</inf>CO<inf>2</inf>, respectively. Low P<inf>et</inf>CO<inf>2</inf> was associated with considerably lower odds of survival (OR 0.12; 95% CI 0.03, 0.47; P=0.003) and additionally increased odds of severe postoperative complications (OR 6.77; 95% CI 1.45, 38.4; P=0.019). Reduced age-predicted DLCO% <80% was associated with increased mortality (HR 5.27; 95% CI 1.09, 25.5; P=0.039). CONCLUSIONS: Assessment of DLCO at rest and dynamic assessment of P<inf>et</inf>CO<inf>2</inf> during the early phase of exercise may potentially be developed as inexpensive point-of-care triage tools to scale objective preoperative risk assessment.
Publisher: Edizioni Minerva Medica
Keywords: Humans; *Carbon Dioxide; Exercise Test/methods; Retrospective Studies; Oxygen Consumption/physiology; Postoperative Complications/epidemiology; *Colorectal Neoplasms/surgery
Department(s): Anaesthetics
PubMed ID: 36326776
Publisher's Version: https://doi.org/10.23736/S0375-9393.22.16872-0
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-09-05 06:53:43

Last Modified: 2023-09-05 06:54:04