Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal...

Area of Science:

• Vascular Surgery
• Cardiopulmonary Exercise Testing
• Risk Stratification

Background:

• National guidelines recommended risk assessment tools for abdominal aortic aneurysms (AAAs).
• Low anaerobic threshold (AT) on cardiopulmonary exercise testing (CPET) predicts poor surgical outcomes.
• CPET assesses pre-operative cardiorespiratory fitness.

Purpose of the Study:

• To evaluate a CPET-based risk-stratification strategy for elective infra-renal AAA repair.
• To assess the impact on perioperative mortality, length of stay, and inpatient costs.

Main Methods:

• Retrospective cohort study comparing patients from 2003-2011.
• Pre-operative CPET introduced in 2007 for risk stratification.
• Analysis of 230 AAA patients (2007-2011) vs. 128 historical controls (2003-2007).

Main Results:

• Patients with AT ≥ 11 ml/kg/min (CPET-pass) showed reduced length of stay (LOS) for both open repair and EVAR.
• CPET-pass group had lower intensive therapy unit (ITU) days, non-operative costs, and perioperative mortality for open repair.
• CPET-stratified patients demonstrated a mid-term survival benefit.

Conclusions:

• Pre-operative AT > 11 ml/kg/min is linked to reduced mortality, LOS, and costs in elective infra-renal AAA surgery.
• CPET-based risk stratification can optimize patient selection and outcomes.
• This strategy benefits both open and endovascular AAA repair procedures.