An evaluation of the validity of the pre-operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery

B. C. Bongers*, A. E. Berkel, J. M. Klaase, N. L. van Meeteren

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

This study aimed to investigate the validity of the oxygen uptake efficiency slope as an objective and submaximal indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery. Patients 60 years of age, with a metabolic equivalent score using the Veterans Activity Questionnaire 7 and scheduled for major colorectal surgery participated in a pre-operative cardiopulmonary exercise test. The oxygen uptake efficiency slope was calculated up to different exercise intensities, using 100%, 90% and 80% of the exercise data. Data from 71 patients (47 men, mean (SD) age 75.2 (6.7) years) were analysed. The efficiency slope obtained from all the data was statistically significantly different from the values when 90% (p = 0.027) and 80% (p = 0.023) of the data were used. The 90% and 80% values did not differ significantly from each other (p = 0.152). Correlations between the oxygen uptake efficiency slope and the peak oxygen uptake ranged from 0.816 to 0.825 (all p <0.001), and correlations between oxygen uptake efficiency slope and the ventilatory anaerobic threshold ranged from 0.793 to 0.805 (all p <0.001). Receiver operating characteristic curves showed that the oxygen uptake efficiency slope is a sensitive and specific predictor of a peak oxygen uptake 18.2 ml.kg(-1).min(-1), with an area under the curve (95%CI) of 0.876 (0.780-0.972, p <0.001) and a ventilatory anaerobic threshold 11.1 ml.kg(-1).min(-1), with an area under the curve (95%CI) of 0.828 (0.726-0.929, p <0.001). These correlations suggest that the oxygen uptake efficiency slope provides a valid (sub)maximal measure of cardiorespiratory fitness in these patients, and the predictive ability described indicates that it might help discriminate patients at higher risk of postoperative morbidity. However, future research should investigate the prognostic value of the oxygen uptake efficiency slope for postoperative outcomes.

Original languageEnglish
Pages (from-to)1206-1216
Number of pages11
JournalAnaesthesia
Volume72
Issue number10
DOIs
Publication statusPublished - Oct 2017

Keywords

  • cardiopulmonary exercise test
  • cardiorespiratory fitness
  • colorectal cancer
  • risk stratification
  • surgery
  • CHRONIC HEART-FAILURE
  • RISK-ASSESSMENT
  • POSTOPERATIVE MORBIDITY
  • INTRAABDOMINAL SURGERY
  • ANAEROBIC THRESHOLD
  • EXERCISE VARIABLES
  • FUNCTIONAL RESERVE
  • HEPATIC RESECTION
  • PROGNOSTIC VALUE
  • CARDIAC PATIENTS

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