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

• Published in: Anaesthesia 2017-10, Vol.72 (10), p.1206-1216
• Main Authors: Bongers, B. C., Berkel, A. E., Klaase, J. M., Meeteren, N. L.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anaerobic Threshold - physiology; Anesthesia; cardiopulmonary exercise test; cardiorespiratory fitness; Cardiorespiratory Fitness - physiology; Colectomy; colorectal cancer; Colorectal Neoplasms - physiopathology; Colorectal Neoplasms - surgery; Colorectal surgery; Computing time; Correlation; Exercise Test - methods; Female; Geriatrics; Humans; Male; Maximum oxygen consumption; Middle Aged; Morbidity; Older people; Oxygen; Oxygen Consumption - physiology; Oxygen uptake; Patients; Physical fitness; Preoperative Care - methods; risk stratification; ROC Curve; Sensitivity and Specificity; surgery
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.14003

Summary 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.