A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: Physiological capacity compared with the ASA physical status classification system

C E Hightower, B J Riedel, B W Feig, G S Morris, J E Ensor Jr, V D Woodruff, M D Daley-Norman, X G Sun, C E Hightower, B J Riedel, B W Feig, G S Morris, J E Ensor Jr, V D Woodruff, M D Daley-Norman, X G Sun

Abstract

Background: This pilot study compared the risk predictive value of preoperative physiological capacity (PC: defined by gas exchange measured during cardiopulmonary exercise testing) with the ASA physical status classification in the same patients (n=32) undergoing major abdominal cancer surgery.

Methods: Uni- and multivariate logistic regression models were fitted to measurements of PC and ASA rank data determining their predictive value for postoperative morbidity. Receiver operating characteristic (ROC) curves were used to discriminate between the predictive abilities, exploring trade-offs between sensitivity and specificity.

Results: Individual statistically significant predictors of postoperative morbidity included the ASA rank [P=0.038, area under the curve (AUC)=0.688, sensitivity=0.630, specificity=0.750] and three newly identified measures of PC: PAT (% predicted anaerobic threshold achieved, <75% vs > or =75%), DeltaHR1 (heart rate response from rest to the anaerobic threshold), and HR3 (heart rate at the anaerobic threshold). A two-variable model of PC measurements (DeltaHR1+PAT) was also shown to be statistically significant in the prediction of postoperative morbidity (P=0.023, AUC=0.826, sensitivity=0.813, specificity=0.688).

Conclusions: Three newly identified PC measures and the ASA rank were significantly associated with postoperative morbidity; none showed a statistically greater association compared with the others. PC appeared to improve predictive sensitivity. The potential for new unidentified measures of PC to predict postoperative outcomes remains unexplored.

Figures

Fig 1
Fig 1
ROC curve for PC model (ΔHR1+PAT) vs ASA in relation to postoperative outcomes (P=0.27).

References

    1. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326–41.
    1. Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA., Jr Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199:531–7.
    1. Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract. 2001;4:172–7.
    1. Garcia-Miguel FJ, Serrano-Aguilar PG, Zlopez-Bastida J. Preoperative assessment. Lancet. 2003;362:1749–57.
    1. Wasserman K, Hansen J, Sue D, et al. Physiology of exercise. In: Wasserman K, editor. Principles of Exercise Testing and Interpretation. Baltimore, MD: Lippincott Williams and Wilkins; 1999. pp. 10–61.
    1. Buchfuhrer MJ, Hansen JE, Robinson TE, Sue DY, Wasserman K, Whipp BJ. Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol. 1983;55:1558–64.
    1. Cary, NC: SAS Institute Inc.; 2003. SAS Release 9.1.3.
    1. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.
    1. Somers R. A new asymmetric measure of association for ordinal variables. Am Sociol Rev. 1962;27:799–811.
    1. College Station, TX: Stata Corporation; 2005. STATA version 9.
    1. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.
    1. Older P, Smith R, Courtney P, Hone R. Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing. Chest. 1993;104:701–4.
    1. Older P, Hall A, Hader R. Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest. 1999;116:355–62.
    1. McCullough PA, Gallagher MJ, Dejong AT, et al. Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest. 2006;130:517–25.
    1. Nagamatsu Y, Shima I, Yamana H, Fujita H, Shirouzu K, Ishitake T. Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus. J Thorac Cardiovasc Surg. 2001;121:1064–8.
    1. Forshaw MJ, Strauss CF, Davies AR, et al. Is cardiopulmonary exercise testing a useful test before esophagaectomy. Ann Thorac Surg. 2008;85:294–9.
    1. Gerson MC, Hurst JM, Hertzberg VS, Baughman R, Rouan GW, Ellis K. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med. 1990;88:101–7.
    1. Lefor AT. Perioperative management of the patient with cancer. Chest. 1999;115:165S–71S.
    1. Thorsen L, Nystad W, Stigum H, et al. Cardiorespiratory fitness in relation to self-reported physical function in cancer patients after chemotherapy. J Sports Med Phys Fitness. 2006;46:122–7.
    1. Mangano DT. Adverse outcomes after surgery in the year 2001—a continuing odyssey. Anesthesiology. 1998;88:561–4.

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