Franssen Ruud F W, Berkel Annefleur E M, Ten Cate David W G, van der Palen Job, van Meeteren Nico L U, Vogelaar F Jeroen, Slooter Gerrit, Klaase Joost M, Janssen-Heijnen Maryska L G, Bongers Bart C
Department of Clinical Physical Therapy, VieCuri Medical Center, Tegelseweg 210, 5912, BL, Venlo, The Netherlands.
Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Langenbecks Arch Surg. 2023 Dec 14;409(1):7. doi: 10.1007/s00423-023-03197-5.
This study aimed to investigate the association of effort-independent variables derived from the preoperative cardiopulmonary exercise test (CPET) with 30-day postoperative complications after elective colorectal surgery.
A multicenter (n=4) retrospective explorative study was performed using data of patients who completed a preoperative CPET and underwent elective colorectal surgery. The preoperative slope of the relation between minute ventilation and carbon dioxide production (VE/VCO-slope) and the oxygen uptake efficiency slope (OUES), as well as 30-day postoperative complications, were assessed. Multivariable logistic regression analyses and receiver operating characteristic (ROC) curves were used to investigate the prognostic value of the relationship between these preoperative CPET-derived effort-independent variables and postoperative complications.
Data from 102 patients (60.1% males) with a median age of 72.0 (interquartile range 67.8-77.4) years were analyzed. Forty-four patients (43.1%) had one or more postoperative complications (of which 52.3% general and 77.3% surgical complications). Merely 10 (9.8%) patients had a general complication only. In multivariate analysis adjusted for surgical approach (open versus minimally invasive surgery), the VE/VCO-slope (odds ratio (OR) 1.08, confidence interval (CI) 1.02-1.16) and OUES (OR 0.94, CI 0.89-1.00) were statistically significant associated with the occurrence of 30-day postoperative complications.
The effort-independent VE/VCO-slope and OUES might be used to assist in future preoperative risk assessment and could especially be of added value in patients who are unable or unwilling to deliver a maximal cardiorespiratory effort. Future research should reveal the predictive value of these variables individually and/or in combination with other prognostic (CPET-derived) variables for postoperative complications.
ClinicalTrials.gov NCT05331196.
本研究旨在探讨术前心肺运动试验（CPET）得出的与努力程度无关的变量与择期结直肠手术后30天术后并发症之间的关联。
采用完成术前CPET并接受择期结直肠手术患者的数据进行多中心（n = 4）回顾性探索性研究。评估术前分钟通气量与二氧化碳产生量之间关系的斜率（VE/VCO斜率）和摄氧效率斜率（OUES）以及术后30天并发症。使用多变量逻辑回归分析和受试者工作特征（ROC）曲线来研究这些术前CPET得出的与努力程度无关的变量与术后并发症之间关系的预后价值。
分析了102例患者（60.1%为男性）的数据，中位年龄为72.0岁（四分位间距67.8 - 77.4岁）。44例患者（43.1%）发生了一种或多种术后并发症（其中52.3%为全身并发症，77.3%为手术并发症）。仅10例（9.8%）患者仅有全身并发症发生。在根据手术方式（开放手术与微创手术）进行调整的多变量分析中，VE/VCO斜率（比值比（OR）1.08，置信区间（CI）1.02 - 1.16）和OUES（OR 0.94，CI 0.89 - 1.）与术后30天并发症的发生在统计学上显著相关。
与努力程度无关的VE/VCO斜率和OUES可能有助于未来的术前风险评估，尤其对于那些无法或不愿意进行最大心肺努力的患者可能具有额外价值。未来的研究应揭示这些变量单独和/或与其他预后（源自CPET的）变量联合对术后并发症的预测价值。
ClinicalTrials.gov NCT05331196 。
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