Study objective: To develop an integrated strategy for
the identification and subsequent management of high-risk patients in
order to reduce both morbidity and mortality.
Prospective consecutive series in which all patients underwent
cardiopulmonary exercise (CPX) testing.
laboratory and level 3 ICU and high-dependency unit (HDU) of a
metropolitan teaching hospital.
Patients: Five hundred
forty-eight patients > 60 years of age (or younger with known
cardiopulmonary disease) scheduled for major intra-abdominal
Interventions: The patients were assigned to
one of three management strategies (ICU, HDU, or ward) based on the
anaerobic threshold (AT) and ECG evidence of myocardial ischemia as
determined by CPX testing that was performed as part of the presurgery
evaluation, and by the expected oxygen demand stress of the surgical
Results: Overall mortality was 3.9%.
Forty-three percent of deaths were attributed to poor cardiopulmonary
function, as detected preoperatively. There were no deaths related to
cardiopulmonary complications in any patient deemed fit for major
abdominal surgery and ward management, as determined by CPX
Conclusions: In elderly patients undergoing
major intra-abdominal surgery, the AT, as determined by CPX testing, is
an excellent predictor of mortality from cardiopulmonary causes in the
postoperative period. Preoperative screening using CPX testing allowed
the identification of high-risk patients and the appropriate selection
of perioperative management.