Ventilatory inefficiency adversely affects outcomes and longer-term survival after planned colorectal cancer surgery
| Autor: | Simon J. Davies, R. Jonathan T. Wilson, David Yates, James P. Walkington |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Population 03 medical and health sciences Oxygen Consumption Postoperative Complications 0302 clinical medicine Risk Factors 030202 anesthesiology Internal medicine Humans Medicine Risk factor education Lung Aged Retrospective Studies Aged 80 and over education.field_of_study Exercise Tolerance business.industry Retrospective cohort study Cardiorespiratory fitness Odds ratio Carbon Dioxide Survival Analysis United Kingdom Colorectal surgery Confidence interval Anesthesiology and Pain Medicine Cohort Exercise Test Female Colorectal Neoplasms Pulmonary Ventilation business Respiration and the Airway |
| Zdroj: | British Journal of Anaesthesia. 123:238-245 |
| ISSN: | 0007-0912 |
| DOI: | 10.1016/j.bja.2019.01.032 |
| Popis: | Background Impaired cardiorespiratory reserve is an accepted risk factor for patients having major surgery. Ventilatory inefficiency, defined by an elevated ratio of minute ventilation to carbon dioxide excretion (VE/VCO2), and measured by cardiopulmonary exercise testing (CPET), is a pathophysiological characteristic of patients with cardiorespiratory disease. We set out to evaluate the prevalence of ventilatory inefficiency in a colorectal cancer surgical population, and its influence on surgical outcomes and long-term cancer survival. Methods In this retrospective study of 1375 patients who had undergone preoperative CPET followed by colorectal cancer surgery, we used receiver operating characteristic curve analysis to identify an optimal value of VE/VCO2 associated with 90-day mortality. Binary logistic regression was used to evaluate whether this degree of ventilatory inefficiency was independently associated with decreased survival, both after surgery and in the longer term. Results We identified an optimal VE/VCO2 >39 cut-off for predicting 90-day mortality; 245 patients (17.8%) had VE/VCO2 >39, of which 138 (10% of total cohort) had no known cardiorespiratory risk factors. Ventilatory inefficiency was independently associated with death at 90-days (8.2% mortality vs 1.9%; adjusted odds ratio [OR], 4.04; 95% confidence interval [CI], 2.09–7.84), with death after unplanned critical care admission (OR=4.45; 95% CI, 1.37–14.46) and with decreased survival at 2 yr (OR=2.21; 95%, 1.49–3.28) and 5 yr (OR=2.87; 95% CI, 1.54–5.37) after surgery. Conclusions A significant proportion of patients having colorectal cancer surgery have ventilatory inefficiency observed on CPET, the majority of whom have no history of cardiorespiratory risk factors. This group of patients has significantly decreased survival both after surgery and in the long-term, irrespective of cancer stage. Survival might be improved by formal medical evaluation and intervention in this group. |
| Databáze: | OpenAIRE |
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