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Cardiopulmonary Exercise Testing in Oesophagogastric Surgery: a Systematic Review.

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Cardiopulmonary exercise testing (CPX) can predict mortality after oesophagogastric surgery. Lower fitness indicators like anaerobic threshold and oxygen consumption on CPX are linked to increased postoperative mortality risk.

Keywords:
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Area of Science:

  • Gastroenterology
  • Cardiology
  • Surgery

Background:

  • Fitness assessment is crucial for predicting surgical outcomes.
  • The prognostic value of cardiopulmonary exercise testing (CPX) in oesophagogastric surgery remains unclear.
  • Upper gastro-intestinal surgery carries significant postoperative risks.

Purpose of the Study:

  • To systematically review and assess the prognostic ability of CPX in predicting postoperative outcomes.
  • To evaluate the relationship between CPX-derived fitness parameters and outcomes in oesophagogastric surgery patients.
  • To determine if CPX can identify patients at higher risk for mortality, morbidity, or prolonged hospital stay.

Main Methods:

  • Systematic literature search of major databases (EMBASE, Medline, CINAHL, Cochrane, Web of Science) up to July 2019.
  • Inclusion of prognostic studies on adult upper gastro-intestinal surgery patients using preoperative CPX.
  • Risk of bias assessment using the QUIPS tool.

Main Results:

  • Thirteen studies with 1735 participants were analyzed.
  • Lower anaerobic threshold and oxygen consumption values on CPX were associated with increased postoperative mortality.
  • Conflicting evidence exists for CPX variables predicting postoperative morbidity.
  • No association found between preoperative CPX and hospital length of stay.

Conclusions:

  • CPX variables, particularly anaerobic threshold and oxygen consumption, show prognostic value for postoperative mortality in oesophagogastric surgery.
  • Evidence regarding CPX's ability to predict postoperative morbidity is inconsistent.
  • Further research is needed to clarify the role of CPX in predicting morbidity and length of stay.