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Original Research: CARDIOTHORACIC SURGERY |

Peak Oxygen Consumption During Cardiopulmonary Exercise Test Improves Risk Stratification in Candidates to Major Lung Resection

Alessandro Brunelli, MD; Romualdo Belardinelli, MD; Majed Refai, MD; Michele Salati, MD; Laura Socci, MD; Cecilia Pompili, MD; Armando Sabbatini, MD
Author and Funding Information

*From the Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.

Correspondence to: Alessandro Brunelli, MD, Via S. Margherita 23, Ancona 60129, Italy; e-mail: alexit_2000@yahoo.com


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(5):1260-1267. doi:10.1378/chest.08-2059
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Background:  The objective of this investigation was to assess the association of peak oxygen consumption (V̇o2) with postoperative outcome in a prospective cohort of patients undergoing major lung resection for the treatment of lung cancer.

Methods:  Preoperative symptom-limited cardiopulmonary exercise testing (CPET) performed using cycle ergometry was conducted in 204 consecutive patients who had undergone pulmonary lobectomy or pneumonectomy. Peak V̇o2 was tested for possible association with postoperative cardiopulmonary complications and mortality. Logistic regression analysis, validated by a bootstrap analysis, was used to adjust for the effect of other perioperative factors. The role of peak V̇o2 in stratifying the surgical risk was further assessed in different groups of patients subdivided according to their cardiorespiratory status.

Results:  Logistic regression showed that peak V̇o2 was an independent and reliable predictor of pulmonary complications (p = 0.04). All six deaths occurred in patients with a peak V̇o2 of < 20 mL/kg/min (four deaths in patients with a peak V̇o2 of < 12 mL/kg/min). The mortality rate in this high-risk group was 10-fold higher (4 of 30 patients; 13%) compared to those with higher peak V̇o2 (p = 0.006). Compared to patients with a peak V̇o2 of > 20 mL/kg/min, those with a peak V̇o2 of < 12 mL/kg/min had 5-fold, 8-fold, 5-fold, and 13-fold higher rates, respectively, of total cardiopulmonary complications pulmonary complications, cardiac complications, and mortality.

Conclusions:  The present study supports a more liberal use of CPET before lung resection compared to the current guidelines since this test can help in stratifying the surgical risk and optimizing perioperative care.

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