Cardiopulmonary exercise testing for preoperative risk assessment before hepatic resection

Br J Surg. 2012 Aug;99(8):1097-104. doi: 10.1002/bjs.8773. Epub 2012 Jun 14.


Background: Contemporary liver surgery practice must accurately assess operative risk in increasingly elderly populations with greater co-morbidity. This study evaluated preoperative cardiopulmonary exercise testing (CPET) in high-risk patients undergoing hepatic resection.

Methods: In a prospective cohort referred for liver resection, patients aged over 65 years (or younger with co-morbidity) were evaluated by preoperative CPET. Data were collected prospectively on functional status, postoperative complications and survival.

Results: Two hundred and four patients were assessed for hepatic resection, of whom 108 had preoperative CPET. An anaerobic threshold (AT) of 9·9 ml O(2) per kg per min predicted in-hospital death and subsequent survival. Below this value, AT was 100 per cent sensitive and 76 per cent specific for in-hospital mortality, with a positive predictive value (PPV) of 19 per cent and a negative predictive value (NPV) of 100 per cent: no deaths occurred above the threshold. Age and respiratory efficiency in the elimination of carbon dioxide (VE/VCO(2)) at AT were statistically significant predictors of postoperative complications. Receiver operating characteristic (ROC) curve analysis showed that a threshold of 34·5 for VE/VCO(2) at AT provided a specificity of 84 per cent and a sensitivity of 47 per cent, with a PPV of 76 (95 per cent confidence interval (c.i.) 58 to 88) per cent and a NPV of 60 (48 to 72) per cent for postoperative complications. Long-term survival of those with an AT of less than 9·9 ml O(2) per kg per min was significantly worse than that of patients with a higher AT (hazard ratio for mortality 1·81, 95 per cent c.i. 1·04 to 3·17; P = 0·036).

Conclusion: CPET provides a useful prognostic adjunct in the preoperative assessment of patients undergoing hepatic resection.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anaerobic Threshold / physiology
  • Cardiovascular Diseases / prevention & control
  • Exercise Test / methods*
  • Female
  • Hepatectomy / methods*
  • Hepatectomy / mortality
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Liver Neoplasms / mortality
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications / prevention & control*
  • Preoperative Care
  • Prospective Studies
  • ROC Curve
  • Respiration Disorders / prevention & control
  • Risk Assessment / methods
  • Young Adult