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

• Published in: British journal of anaesthesia : BJA Vol. 104; no. 4; pp. 465 - 471
• Main Authors: Hightower, C.E., Riedel, B.J., Feig, B.W., Morris, G.S., Ensor, J.E., Woodruff, V.D., Daley-Norman, M.D., Sun, X.G.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-04-2010; Oxford University Press
• Subjects: Abdominal Neoplasms - physiopathology; Abdominal Neoplasms - surgery; Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; assessment; assessment, preanaesthetic; Biological and medical sciences; complications; complications, morbidity; Critical Care; Epidemiologic Methods; Exercise Test - methods; Female; gas exchange metabolic; Health Status Indicators; Humans; Male; measurement techniques; measurement techniques, gas exchange metabolic; Medical sciences; metabolism; metabolism, oxygen consumption; Middle Aged; morbidity; oxygen consumption; Oxygen Consumption - physiology; oxygen uptake; postoperative; preanaesthetic; Preoperative Care - methods; Prognosis; Pulmonary Gas Exchange - physiology; risk; surgery; surgery, postoperative; Treatment Outcome; Young Adult; measurement techniques, gas exchange metabolic; metabolism, oxygen consumption; complications, morbidity; oxygen uptake; surgery, postoperative; assessment, preanaesthetic; risk; Postoperative; Oxygen; Prognosis; Oxygen consumption; Metabolism; Uptake; Morbidity; Measurement technique; Surgery; Classification; Risk factor; Anesthesia; Complication; Gas exchange
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aeq034

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.
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.
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 ≥75%), ΔHR1 (heart rate response from rest to the anaerobic threshold), and HR3 (heart rate at the anaerobic threshold). A two-variable model of PC measurements (ΔHR1+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).
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.