Chan K E, Pathak S, Smart N J, Batchelor N, Daniels I R
Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter Hospital, Exeter, UK.
Department of Anaesthesia, Royal Devon and Exeter Hospital, Exeter, UK.
Colorectal Dis. 2016 Jun;18(6):578-85. doi: 10.1111/codi.13139.
Advanced age and occult cardiorespiratory disease are associated with increased morbidity and mortality following surgery. Cardiopulmonary exercise testing (CPET) may allow the identification of high-risk patients and facilitate planned postoperative critical care support. The aim of this study was to determine whether preoperative CPET in patients aged over 80 undergoing elective colorectal cancer resection was associated with improved outcome.
All patients aged 80 years and above undergoing elective colorectal cancer resection between 1 March 2011 and 1 September 2013 were retrospectively analysed. Referral for CPET testing was at the discretion of the operating surgeon. Postoperative critical care unit (CCU) admission was based upon the CPET results.
Ninety-four patients were identified, of whom 48 underwent CPET testing. The CPET group were significantly older than the non-CPET group (85 vs 83 years, P = 0.04) and were more likely to have a planned admission to CCU postoperatively (P < 0.0001). Despite the increased use of CCU resources, the overall CCU length of stay (LOS) in the CPET group did not differ from the non-CPET group, but the non-CPET group had a higher proportion of Level-3 care. There were no differences in the incidence of unplanned CCU admission between the CPET and the non-CPET group (P = 0.23). There were no differences in overall LOS between the two groups (P = 0.42). There was no difference in mortality (P = 0.11), overall complications (P = 0.53) or severe complications (P = 0.3).
Preoperative CPET testing in patients aged over 80 undergoing elective colorectal cancer resection allows identification of higher-risk patients and mitigation of risk by preemptive admission to a CCU. This stratification allows equivalent results to be achieved in high- and low-risk elderly patients undergoing colorectal surgery.
高龄和隐匿性心肺疾病与术后发病率和死亡率增加相关。心肺运动试验（CPET）可能有助于识别高危患者，并为术后重症监护支持提供便利。本研究的目的是确定80岁以上接受择期结直肠癌切除术的患者术前CPET是否与改善预后相关。
对2011年3月1日至2013年9月1日期间所有80岁及以上接受择期结直肠癌切除术的患者进行回顾性分析。是否进行CPET检测由主刀医生自行决定。术后重症监护病房（CCU）的收治依据CPET结果。
共确定94例患者，其中48例接受了CPET检测。CPET组患者的年龄显著大于非CPET组（85岁对83岁，P = 0.04），且术后更有可能计划入住CCU（P < 0.0001）。尽管CPET组使用CCU资源更多，但其在CCU的总住院时间（LOS）与非CPET组并无差异，但非CPET组接受三级护理的比例更高。CPET组和非CPET组计划外入住CCU的发生率无差异（P = 0.23）。两组的总住院时间无差异（P = 0.42）。死亡率（P = 0.11）、总体并发症（P = 0.53）或严重并发症（P = 0.3）方面均无差异。
80岁以上接受择期结直肠癌切除术的患者术前进行CPET检测，有助于识别高危患者，并通过提前入住CCU来降低风险。这种分层使得接受结直肠手术的高危和低危老年患者能够取得相当的结果。
