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Impaired cardiopulmonary reserve in an elderly population is related to postoperative morbidity and length of hospital stay after radical cystectomy

Lookup NU author(s): Professor Michael Trenell, Nikil Vasdev, Dr Christopher Snowden

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Abstract

Objective To determine the relationship of preoperatively measured cardiorespiratory function, to the development of postoperative complications and length of hospital stay (LOS) in a cohort of patients undergoing radical cystectomy (RC), as RC and conduit formation is curative but is associated with significant postoperative morbidity and mortality. Patients and Methods Consecutive patients planned to have RC underwent cardiopulmonary exercise testing (CPET) to a standardised protocol. The results of the CPET were blinded' from the clinicians involved in the care of the patients. Patients were prospectively monitored for the primary outcome of postoperative complications, as defined by a validated classification (Clavien-Dindo). Secondary outcome included LOS and mortality. Results In all, 82 patients underwent CPET before RC. Eight patients did not subsequently undergo RC and a further five did not exercise sufficiently to allow for appropriate determination of the cardiopulmonary variables of interest. There was a significant difference in LOS between those patients who had a major perioperative complication (Clavien score > 3) and those that did not (16 vs 30 days; P < 0.001; hazard ratio [HR] 3.6, 95% confidence interval [CI] 2.1-6.3). The anaerobic threshold (AT) remained as the only significant independent predictor variable for the presence or absence of major postoperative complications (odds ratio 0.74, 95% CI 0.57-0.97; P = 0.03). When the optimal predictive value of AT of 12mL/min/kg was used as a fitness marker, there was a significant relationship between fitness and LOS (median LOS: unfit' 22 days vs fit' 16 days; HR 0.47, 95% CI 0.28-0.80; P = 0.006) Conclusion Impaired preoperative cardiopulmonary reserve was related to major morbidity, prolonged LOS and increased use of critical care resource after RC. This has important health and economic implications for risk assessment, rationalisation of postoperative resource and the potential for therapeutic preoperative intervention with exercise therapy.


Publication metadata

Author(s): Prentis JM, Trenell MI, Vasdev N, French R, Dines G, Thorpe A, Snowden CP

Publication type: Article

Publication status: Published

Journal: BJU International

Year: 2013

Volume: 112

Issue: 2

Pages: E13-E19

Print publication date: 01/07/2013

Online publication date: 25/06/2013

ISSN (print): 1464-4096

ISSN (electronic): 1464-410X

Publisher: Wiley-Blackwell

URL: http://dx.doi.org/10.1111/bju.12219

DOI: 10.1111/bju.12219


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