Kamp, M.S. van (2013) “The optimal anaerobic threshold value to predict high- and low-risk groups for postoperative complications after elective colon surgery”. thesis, Medicine.
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Abstract
Background: Colorectal cancer primarily occurs in the elderly. With the increase in ageing population, surgical interventions have almost doubled in patients aged over 75 years in the last two decades. The ageing process makes elderly patients more susceptible to postoperative complications. According to the Dutch Surgical Colorectal Audit, 33 percent of the colorectal patients suffer from one or more postoperative complications. Identifying these high-risk patients help the clinician make appropriate decisions about offering surgery and for the efficient use of health care resources. Cardiopulmonary exercise testing is an accurate tool to predict patients at risk by determining the anaerobic threshold. Although there are many studies about the association between the AT and postoperative complications, there is still no optimal AT value to predict high-risk groups for postoperative complications after elective colon surgery. Based on previous studies we hypothesize that patients with an anaerobic threshold below 11 ml/kg/min have more postoperative complications following elective colon surgery for colon cancer than patients with an anaerobic threshold above 11 ml/kg/min. Objective: The primary objective of this research is to determine which AT cut off point is the optimal value to predict high- and low-risk groups for postoperative complications seven days after elective colon surgery. The secondary objectives are to determine the optimal AT cut off point 30 days after surgery and to determine whether there is a difference in length of hospital stay in high- and low-risk groups. Patient and methods: Between March 2013 and July 2013 we performed a prospective observational, single centre cohort study to determine the optimal AT cut off point for determining the risk of postoperative complications. A preoperative CPET was performed in subjective unfit patients with colon cancer who were scheduled for elective colon surgery in Medisch Spectrum Twente. Results: Ten patients were included. Eight patients achieved an anaerobic threshold below 11 ml/kg/min and two above 11 ml/kg/min. The number of patients with an AT above 11 ml/kg was not sufficient for statistical analysis. 3 patients suffered from postoperative complications from which 2 are classified as minor and 1 as a major complication. The group with complications scored a lower median AT compared to the group without complications (8.6 vs. 9.0 ml/kg/min; P = 0.425). There were no significant differences between the group with and without complications. ROC curve analysis showed an optimal AT of 10 ml/kg/min to predict the risk of postoperative complications 7 days after elective colon surgery (sensitivity 100%, specificity 43%, AUC 0.714, P = 0.305) and 9 ml/kg/min for 30 days after surgery. The outcomes were not significant. De median length of hospital stay was 7 days. De median length of hospital stay in the high-risk group was 3 days longer than the length of hospital stay in the low-risk group (9 vs. 6 days, P = 0.105). Conclusions: The number of included patients with an AT above 11 ml/kg/min was insufficient to statistically analyse if an anaerobic threshold of 11 ml/kg/min was the optimal cut off point. Receiver Operator Characteristics curve analysis showed an optimal AT cut off point of 10 ml/kg/min and 9 ml/kg/min for 7 and 30 days after surgery, respectively. The median length of hospital stay in the high-risk group was 3 days longer than the median length of stay in the low-risk group. The study was, however, underpowered which resulted in no significant outcomes. This pilot study does show that CPET is a safe and well-tolerated test. A bigger sample size is required to obtain statistically significant results.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Klaase, Dr. J.M. and Jongh, F. de and Medisch Spectrum Twente and Enschede. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:54 |
| Last Modified: | 25 Jun 2020 10:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1493 |
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