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Submaximal exercise testing predicts perioperative hospitalization after aortic aneurysm repair

Lookup NU author(s): Dr Michael Prentis, Professor Mike Trenell, Professor David Jones, Tim Lees, Dr Christopher Snowden

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Abstract

Background: Aortic aneurysm repair is a high-risk surgical procedure. Patients are often elderly, with multiple comorbidities that predispose them to perioperative morbidity. Use of endovascular aneurysm repair (EVAR) has increased due to reduced early perioperative risk. This study assessed whether preoperative cardiopulmonary exercise testing (CPET) could be used to predict morbidity and hospital length of stay (LOS) after aortic aneurysm repair. Methods: A total of 185 patients underwent surgical repair (84 open repairs, 101 EVAR) and had adequate determination of a submaximal CPET parameter (anaerobic threshold). Results: Patient comorbidities and cardiorespiratory fitness, derived from CPET, were similar between surgical procedures. Patients undergoing EVAR had fewer complications (10% vs 32%; P < .0001) and shorter mean (standard deviation [SD]) hospital LOS of 5.7 (9.3) days vs 14.4 (10.9) days compared with open repair (P < .0001). The hospital LOS was significantly increased in patients with one or more complications in both groups compared with those with no complications. In the open repair group, the level of fitness, as defined by anaerobic threshold, was an independent predictor of postoperative morbidity and hospital LOS. When the optimal anaerobic threshold (10 mL/min/kg) derived from receiver operator curve analysis was used as a cutoff value, unfit patients stayed significantly longer than fit patients in critical care (mean, 6.4 [SD, 6.9] days vs 2.4 [SD, 2.9] days; P = .002) and in the hospital (mean, 23.1 [SD, 14.8] days vs 11.0 [SD, 6.1] days; P < .0001). In contrast, fitness in the EVAR group was not predictive of postoperative morbidity but did have predictive value for hospital LOS. Conclusions: Cardiorespiratory fitness holds significant clinical value before aortic aneurysm repair in predicting postsurgical complications and duration of critical care and hospital LOS. Preoperative measurement of fitness could then direct clinical management with regard to operative choice, postoperative resource allocation, and informed patient decision making. (J Vasc Surg 2012;56:1564-70.)


Publication metadata

Author(s): Prentis JM, Trenell MI, Jones DJ, Lees T, Clarke M, Snowden CP

Publication type: Article

Publication status: Published

Journal: Journal of Vascular Surgery

Year: 2012

Volume: 56

Issue: 6

Pages: 1564-1570

Print publication date: 01/12/2012

ISSN (print): 0741-5214

ISSN (electronic): 1097-6809

Publisher: Mosby, Inc.

URL: http://dx.doi.org/10.1016/j.jvs.2012.05.097

DOI: 10.1016/j.jvs.2012.05.097


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