Preoperative submaximal cardiopulmonary exercise testing and its association with early postoperative complications

Authors

Zyad J. Carr, Yale University, School of Medicine, New Haven, CT, USA.
Jean Charchaflieh, Yale University, School of Medicine, New Haven, CT, USA.
Andres Brenes-Bastos, Yale University, School of Medicine, New Haven, CT, USA.
Hugo He, Yale Center for Analytical Sciences, New Haven, CT, USA.
Hung-Mo Lin, Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT, USA.
Amanda Jankelovits, Yale University, School of Medicine, New Haven, CT, USA.
Emily Gu, Yale University, School of Medicine, New Haven, CT, USA.
Jill Zafar, Yale University, School of Medicine, New Haven, CT, USA.
Fed Ghali, Yale University, School of Medicine, New Haven, CT, USA.
Wei S. Tan, Yale University, School of Medicine, New Haven, CT, USA.
Paul Heerdt, Yale University, School of Medicine, New Haven, CT, USA.

Document Type

Article

Publication Title

BJA open

Abstract

BACKGROUND: Early postoperative complication risk prediction would enhance perioperative surveillance and resource allocation. Reports have described brief submaximal cardiopulmonary exercise testing (CPET) for the routine assessment of cardiopulmonary disease. Compared with conventional CPET, it can be performed in 6 min and is used to predict peak CPET measurements. We aimed to determine whether submaximal CPET-derived measures outperform structured surveys in early postoperative complication detection. METHODS: An institutional review board-approved, single-centre, open-label, clinical device trial was conducted. A total of 101 participants undergoing noncardiac surgery, aged >60 yr, with revised cardiac risk index ≤2, self-reported metabolic equivalents >4 (METs in ml O kg min; self-endorsed reliably climbing two flights of stairs), were enrolled. Participants completed a subjective METs assessment, Duke Activity Status Index, and submaximal CPET that derived peak oxygen uptake (VO, ml Okg min), METs, and gas exchange-derived pulmonary capacitance (GXCAP, in ml O beat kPa). Elastic net regularisation machine learning identified feature importance among study measures for the primary endpoint (Postoperative Morbidity Survey [POMS] ≥1), secondary endpoints (cardiac, pulmonary and renal domains of the POMS [POMS-CPR ≥1]), and length of stay. Adjusted multivariable regression models were used to identify significance. RESULTS: Of 101 participants, 53 (52.4%) had POMS ≥1. GXCAP to peak VO slope (GXCAP-VO) was associated with POMS ≥1 (OR 0.94; 95% CI 0.89-0.99; P=0.011) and increasing length of stay (OR 0.98; 95% CI 0.96-0.99; P=0.01). GXCAP-VO slope (OR 0.93; 95% CI 0.88-0.99; P=0.015) was associated with POMS-CPR ≥1. CONCLUSIONS: Compared with structured surveys (subjective METs or Duke Activity Status Index) or conventional peak CPET values (VO or METs), a novel measure, GXCAP-VO slope, offered superior early postoperative complication discrimination in low-morbidity subjects. These preliminary findings support GXCAP-VO slope as a compelling investigational target for early postoperative complication risk, supporting the use of CPET to enhance early postoperative complication prediction. CLINICAL TRIAL REGISTRATION: NCT05743673.

First Page

100407

DOI

10.1016/j.bjao.2025.100407

Publication Date

6-1-2025

Recommended Citation

Carr, Zyad J.; Charchaflieh, Jean; Brenes-Bastos, Andres; He, Hugo; Lin, Hung-Mo; Jankelovits, Amanda; Gu, Emily; Zafar, Jill; Ghali, Fed; Tan, Wei S.; and Heerdt, Paul, "Preoperative submaximal cardiopulmonary exercise testing and its association with early postoperative complications" (2025). Surgery. 269.
https://scholar.bridgeporthospital.org/surgery/269

Identifier

40421445 (pubmed); PMC12105740 (pmc); 10.1016/j.bjao.2025.100407 (doi); S2772-6096(25)00031-0 (pii)