Does the introduction of pre-operative cardiopulmonary exercise testing in radical cystectomy delay or alter surgical care?

Autor: Lockhart KR; John Hunter Hospital Newcastle New South Wales Australia., Carroll R; John Hunter Hospital Newcastle New South Wales Australia., Tiu A; John Hunter Hospital Newcastle New South Wales Australia., Blatt A; John Hunter Hospital Newcastle New South Wales Australia.
Jazyk: angličtina
Zdroj: BJUI compass [BJUI Compass] 2021 Dec 12; Vol. 3 (3), pp. 238-242. Date of Electronic Publication: 2021 Dec 12 (Print Publication: 2022).
DOI: 10.1002/bco2.133
Abstrakt: Objectives: To assess if the introduction of routine pre-operative cardiopulmonary exercise testing (CPET) in radical cystectomy has delayed surgical intervention.
Materials and Methods: A prospective database of patients undergoing radical cystectomy in our local health network was maintained. A retrospective analysis of two years (2018-2020) included 38 patients. Of these, 15 patients had CPET pre-operatively, and a direct comparison was performed.
Results: The mean time from diagnosis to cystectomy was 95 days in patients who did not have CPET compared to 110 days for those who did ( p  = 0.32), with comparable rates of neoadjuvant chemotherapy (NAC) (62.5% and 64.29%). Average length of stay was 18.6 days compared with 13.87 ( p  = 0.16), favouring the CPET group. The CPET group also had a lower readmission rate within 30 days (13.33% compared with 21.05%, p  = 0.35). Cause-specific mortality within 90 days was 10.2% and within the study timeframe was 36.84% (estimated 5-year mortality rate 43-65%). Within the CPET group, eight had an anaerobic threshold (AT) of <11 ml/kg/min (range 6.3-10.5): Of these, 50% had Clavien-Dindo complications of grade 2 or higher and the 90-day mortality rate was 37.5% (cf. 0% in those with AT > 11 ml/kg/min in this series).
Conclusion: CPET is a valuable risk evaluation tool. This study suggested that CPET contributed to a minor non-significant delay to surgery, however was associated with reduced length of stay and readmission rates, and was a valuable risk evaluation tool. We found that CPET AT <11 ml/kg/min is associated with higher rates of patient morbidity and perioperative mortality.
Competing Interests: All authors declare that they have no conflict of interest or additional sources of support or funding to declare.
(© 2021 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)
Databáze: MEDLINE
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