Department of Anaesthesia, The Geelong Hospital, Ryrie Street, Geelong, VIC 3220, Australia.
Br J Anaesth. 2012 Nov;109(5):735-41. doi: 10.1093/bja/aes263. Epub 2012 Aug 21.
Cardiopulmonary exercise testing (CPET) is used to assess perioperative risk in surgical patients. While previous studies have looked at short-term outcomes, this paper explores the ability of CPET to predict 5 yr survival after major surgery.
Over a period (1996-2009), 1725 patients referred for CPET subsequently underwent major surgery. Breath-by-breath data derived during each patient's CPET was processed using customized software to extract variables likely to impact on survival. Initial analysis examined the predictive power of single variables. Subsequently, Bayesian model averaging (BMA) was used to construct a multivariate model defining the association between CPET data and 5 yr survival.
Six hundred and sixteen (36%) of the study patients died. Single variables were not significantly associated with 5 yr postoperative survival. BMA indicated the following major predictors of 5 yr survival: patient gender; type of surgery, and forced vital capacity. Four variables derived at the patient's anaerobic threshold were weaker predictors. These were end-tidal oxygen concentration, respiratory exchange ratio, oxygen consumption per unit body weight, and oxygen consumption per heart beat. The resulting model was then used to divide patients into low-, medium-, or high-risk categories, and 5 yr survival for each category was 87.8; 75.8, and 53.8% respectively. Survival was independent of patient age.
Multivariate analysis and model generation techniques can be applied to CPET data to predict 5 yr survival after major surgery more accurately than is possible with single variable analysis.
心肺运动测试（CPET）用于评估手术患者的围手术期风险。虽然之前的研究着眼于短期结果，但本文探讨了 CPET 预测主要手术后 5 年生存率的能力。
在一段时间内（1996-2009 年），1725 名接受 CPET 检查的患者随后接受了大手术。使用定制软件处理每位患者 CPET 期间的逐口气数据，以提取可能影响生存的变量。初步分析检查了单个变量的预测能力。随后，贝叶斯模型平均（BMA）用于构建一个多变量模型，定义 CPET 数据与 5 年生存率之间的关联。
研究患者中有 616 人（36%）死亡。单一变量与 5 年术后生存率无显著相关性。BMA 表明以下是 5 年生存的主要预测因素：患者性别；手术类型和用力肺活量。在患者的无氧阈值处得出的四个变量是较弱的预测因素。这些是呼气末氧浓度、呼吸交换率、单位体重耗氧量和每搏耗氧量。然后，使用该模型将患者分为低风险、中风险或高风险类别，每个类别的 5 年生存率分别为 87.8%、75.8%和 53.8%。生存率与患者年龄无关。
多元分析和模型生成技术可应用于 CPET 数据，比单变量分析更准确地预测主要手术后 5 年的生存率。
