验证术前心肺运动试验衍生变量对大型结直肠手术后院内发病率的预测价值。

Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery.

机构信息

Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.

Critical Care Research Area, National Institute for Health Research Respiratory Biomedical Research Unit, Southampton, UK.

出版信息

Br J Surg. 2016 May;103(6):744-752. doi: 10.1002/bjs.10112. Epub 2016 Feb 23.

DOI:10.1002/bjs.10112

PMID:26914526

Abstract

BACKGROUND

In single-centre studies, postoperative complications are associated with reduced fitness. This study explored the relationship between cardiorespiratory fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after major elective colorectal surgery.

METHODS

Patients underwent preoperative CPET with recording of in-hospital morbidity. Receiver operating characteristic (ROC) curves and logistic regression were used to assess the relationship between CPET variables and postoperative morbidity.

RESULTS

Seven hundred and three patients from six centres in the UK were available for analysis (428 men, 275 women). ROC curve analysis of oxygen uptake at estimated lactate threshold (V˙o at θ^ ) and at peak exercise (V˙o ) gave an area under the ROC curve (AUROC) of 0·79 (95 per cent c.i. 0·76 to 0·83; P < 0·001; cut-off 11·1 ml per kg per min) and 0·77 (0·72 to 0·82; P < 0·001; cut-off 18·2 ml per kg per min) respectively, indicating that they can identify patients at risk of postoperative morbidity. In a multivariable logistic regression model, selected CPET variables and body mass index (BMI) were associated significantly with increased odds of in-hospital morbidity (V˙o at θ^ 11·1 ml per kg per min or less: odds ratio (OR) 7·56, 95 per cent c.i. 4·44 to 12·86, P < 0·001; V˙o 18·2 ml per kg per min or less: OR 2·15, 1·01 to 4·57, P = 0·047; ventilatory equivalents for carbon dioxide at estimated lactate threshold (V˙ /V˙co at θ^ ) more than 30·9: OR 1·38, 1·00 to 1·89, P = 0·047); BMI exceeding 27 kg/m : OR 1·05, 1·03 to 1·08, P < 0·001). A laparoscopic procedure was associated with a decreased odds of complications (OR 0·30, 0·02 to 0·44; P = 0·033). This model was able to discriminate between patients with, and without in-hospital morbidity (AUROC 0·83, 95 per cent c.i. 0·79 to 0·87). No adverse clinical events occurred during CPET across the six centres.

CONCLUSION

These data provide further evidence that variables derived from preoperative CPET can be used to assess risk before elective colorectal surgery.

摘要

背景

在单中心研究中，术后并发症与体能下降有关。本研究探讨了心肺运动测试（CPET）得出的心肺适能变量与择期结直肠手术后住院期间发病率之间的关系。

方法

患者接受术前 CPET，并记录住院期间的发病率。采用受试者工作特征（ROC）曲线和逻辑回归分析 CPET 变量与术后发病率之间的关系。

结果

英国 6 个中心的 703 例患者（428 例男性，275 例女性）可用于分析。摄氧量在估计乳酸阈时（V˙o 在θ^时）和峰值运动时（V˙o ）的 ROC 曲线分析得出 ROC 曲线下面积（AUROC）分别为 0.79（95%可信区间 0.76 至 0.83；P<0.001；截距 11.1 ml/kg/min）和 0.77（0.72 至 0.82；P<0.001；截距 18.2 ml/kg/min），表明它们可以识别术后发病率高的患者。在多变量逻辑回归模型中，选定的 CPET 变量和体重指数（BMI）与住院发病率的增加显著相关（V˙o 在θ^时为 11.1 ml/kg/min 或更低：比值比（OR）7.56，95%可信区间 4.44 至 12.86，P<0.001；V˙o 为 18.2 ml/kg/min 或更低：OR 2.15，1.01 至 4.57，P=0.047；在估计乳酸阈时，二氧化碳通气当量（V˙/V˙co 在θ^时）大于 30.9：OR 1.38，1.00 至 1.89，P=0.047）；BMI 超过 27 kg/m^2：OR 1.05，1.03 至 1.08，P<0.001）。腹腔镜手术与并发症的几率降低相关（OR 0.30，0.02 至 0.44；P=0.033）。该模型能够区分住院期间有和没有发病率的患者（AUROC 0.83，95%可信区间 0.79 至 0.87）。六个中心的 CPET 过程中均未发生不良临床事件。