Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands.
Colorectal Dis. 2022 Jan;24(1):93-101. doi: 10.1111/codi.15941. Epub 2021 Oct 20.
Although cardiopulmonary exercise testing (CPET) is considered the gold standard, a preoperative abdominal CT scan might also provide information concerning preoperative aerobic fitness for risk assessment. This study aimed to investigate the association between preoperative CT-scan-derived body composition variables and preoperative CPET variables of aerobic fitness in colorectal surgery.
In this retrospective cohort study, CT images at level L3 were analysed for skeletal muscle mass, skeletal muscle radiation attenuation, visceral adipose tissue (VAT) mass and subcutaneous adipose tissue mass. Regression analyses were performed to investigate the relation between CT-scan-derived body composition variables, CPET-derived aerobic fitness and other preoperative patient-related variables. Logistic regression analysis was performed to predict a preoperative anaerobic threshold (AT) ≤ 11.1 ml/kg/min as cut-off for having a high risk for postoperative complications.
Data from 78 patients (45 men; mean [SD] age 74.5 [6.4 years]) were analysed. A correlation coefficient of 0.55 was observed between absolute AT and skeletal muscle mass index. Absolute AT (R of 51.1%) was lower in patients with a lower skeletal muscle mass index, together with higher age, lower body mass and higher American Society of Anesthesiologists (ASA) score. Higher ASA score (odds ratio 5.64; P = 0.033) and higher VAT mass (odds ratio 1.02; P = 0.036) were associated with an increased risk of an AT ≤ 11.1 ml/kg/min.
Body composition variables from the preoperative CT scan were moderately associated with preoperative CPET-derived aerobic fitness. Higher ASA score and higher VAT mass were associated with an increased risk of an AT ≤ 11.1 ml/kg/min.
虽然心肺运动测试（CPET）被认为是金标准，但术前腹部 CT 扫描也可能提供有关术前有氧健身的风险评估信息。本研究旨在探讨结直肠手术前 CT 扫描衍生的身体成分变量与 CPET 衍生的有氧健身之间的关系。
在这项回顾性队列研究中，对 L3 水平的 CT 图像进行分析，以获取骨骼肌质量、骨骼肌辐射衰减、内脏脂肪组织（VAT）质量和皮下脂肪组织质量。进行回归分析以调查 CT 扫描衍生的身体成分变量、CPET 衍生的有氧健身与其他术前患者相关变量之间的关系。进行逻辑回归分析以预测术前无氧阈值（AT）≤11.1ml/kg/min 作为术后并发症高风险的预测指标。
共分析了 78 例患者（45 例男性；平均[标准差]年龄 74.5[6.4 岁]）的数据。绝对 AT 与骨骼肌质量指数之间观察到 0.55 的相关系数。骨骼肌质量指数较低的患者，其绝对 AT （R 为 51.1%）较低，同时年龄较大、体重较低、美国麻醉医师协会（ASA）评分较高。较高的 ASA 评分（优势比 5.64；P=0.033）和较高的 VAT 质量（优势比 1.02；P=0.036）与 AT≤11.1ml/kg/min 的风险增加相关。
术前 CT 扫描的身体成分变量与术前 CPET 衍生的有氧健身中等相关。较高的 ASA 评分和较高的 VAT 质量与 AT≤11.1ml/kg/min 的风险增加相关。
