Preoperative aerobic fitness and perioperative outcomes in patients undergoing cystectomy before and after implementation of a national lockdown.

Autor:	Tetlow N; Department of Anaesthesia and Peri-operative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.; Centre for Peri-operative Medicine, Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK.; Human Physiology and Performance Laboratory (HPPL), Centre for Peri-operative Medicine, Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK., Dewar A; Department of Anaesthesia and Peri-operative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.; Human Physiology and Performance Laboratory (HPPL), Centre for Peri-operative Medicine, Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK., Arina P; Human Physiology and Performance Laboratory (HPPL), Centre for Peri-operative Medicine, Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK.; Bloomsbury Institute for Intensive Care Medicine, University College London, London, UK., Tan M; Department of Anaesthesia and Peri-operative Medicine, University College London Hospitals NHS Foundation Trust, London, UK., Sridhar AN; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK., Kelly JD; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK., Arulkumaran N; Human Physiology and Performance Laboratory (HPPL), Centre for Peri-operative Medicine, Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK.; Bloomsbury Institute for Intensive Care Medicine, University College London, London, UK., Stephens RCM; Department of Anaesthesia and Peri-operative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.; Centre for Peri-operative Medicine, Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK., Martin DS; Peninsula Medical School, University of Plymouth, Plymouth, UK., Moonesinghe SR; Department of Anaesthesia and Peri-operative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.; Centre for Peri-operative Medicine, Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK., Whittle J; Department of Anaesthesia and Peri-operative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.; Centre for Peri-operative Medicine, Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK.; Human Physiology and Performance Laboratory (HPPL), Centre for Peri-operative Medicine, Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK.
Jazyk:	angličtina
Zdroj:	BJA open [BJA Open] 2024 Jan 17; Vol. 9, pp. 100255. Date of Electronic Publication: 2024 Jan 17 (Print Publication: 2024).
DOI:	10.1016/j.bjao.2023.100255
Abstrakt:	Background: Lower fitness is a predictor of adverse outcomes after radical cystectomy. Lockdown measures during the COVID-19 pandemic affected daily physical activity. We hypothesised that lockdown during the pandemic was associated with a reduction in preoperative aerobic fitness and an increase in postoperative complications in patients undergoing radical cystectomy. Methods: We reviewed routine preoperative cardiopulmonary exercise testing (CPET) data collected prior to the pandemic (September 2018 to March 2020) and after lockdown (March 2020 to July 2021) in patients undergoing radical cystectomy. Differences in CPET variables, Postoperative Morbidity Survey (POMS) data, and length of hospital stay were compared. Results: We identified 267 patients (85 pre-lockdown and 83 during lockdown) who underwent CPET and radical cystectomy. Patients undergoing radical cystectomy throughout lockdown had lower ventilatory anaerobic threshold (9.0 [7.9-10.9] vs 10.3 [9.1-12.3] ml kg -1 min -1 ; P =0.0002), peak oxygen uptake (15.5 [12.9-19.1] vs 17.5 [14.4-21.0] ml kg -1 min -1 ; P =0.015), and higher ventilatory equivalents for carbon dioxide (34.7 [31.4-38.5] vs 33.4 [30.5-36.5]; P =0.030) compared with pre-lockdown. Changes were more pronounced in males and those aged >65 yr. Patients undergoing radical cystectomy throughout lockdown had a higher proportion of day 5 POMS-defined morbidity (89% vs 75%, odds ratio [OR] 2.698, 95% confidence interval [CI] 1.143-6.653; P =0.019), specifically related to pulmonary complications (30% vs 13%, OR 2.900, 95% CI 1.368-6.194; P =0.007) and pain (27% vs 9%, OR 3.471, 95% CI 1.427-7.960; P =0.004), compared with pre-lockdown on univariate analysis. Conclusions: Lockdown measures in response to the COVID-19 pandemic were associated with a reduction in fitness and an increase in postoperative morbidity among patients undergoing radical cystectomy. (© 2023 The Authors.)
Databáze:	MEDLINE
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