Clinical Correlation between Cardiorespiratory fitness and Functional Mobility and Associations with Postoperative Outcome in Elderly Patients scheduled for Elective Colorectal Resection

Reuding, M. (Muriel) (2017) Clinical Correlation between Cardiorespiratory fitness and Functional Mobility and Associations with Postoperative Outcome in Elderly Patients scheduled for Elective Colorectal Resection. thesis, Medicine.

Text ReudinkM.pdf Restricted to Registered users only Download (1MB)

Abstract

BACKGROUND Morbidity rates after colorectal resection are high in patients with poor preoperative fitness. An impaired postoperative recovery has a significant impact on the overall health. Specific preoperative risk stratification is important to identify patients at risk. Cardiopulmonary exercise testing (CPET) is the gold standard to measure cardiorespiratory fitness and the relative oxygen uptake (VO2) at anaerobic threshold (AT) (mL/kg/min) has been shown to be a good predictor of postoperative outcome. CPET is however an expensive and invasive tool and in current management not used very often. If CPET can be replaced by The ‘Timed-up-and-Go’ test (TUG) (sec), measuring functional mobility has not been studied yet. METHODS We conducted a sub analysis of a prospective randomized controlled trial that took place in Medical Spectrum Twente in Enschede. From February 2014 to February 2017 patients aged > 60 years with subjective low fitness (T1) and scheduled for colorectal resection were included and performed CPET and TUG during preoperative assessment (T2). A VO2 at AT < 11 mL/kg/min was used to identify high risk patients. Associations between the level of AT and TUG were evaluated using linear regression analysis. Possible predictors of undesired short-term postoperative outcome (T3) were identified using univariate and multivariate logistic regression analysis. RESULTS Seventy-five patients, with a mean age of 74 years, were included. The TUG was negatively correlated with the VO2 at AT (r=-0.413 p=0.001), slightly improving to r= -0.416 p=0.008 when only analyzing high risk patients. In our model, the TUG in combination with BMI explained 28% of the variance of VO2 at AT in high risk patients. Eventually postoperative outcome was analyzed in 43 patients, of whom 22 patients (51.2%) developed one or more complications. The presence of complications was almost half as low in the intermediate risk group compared to the high risk group (36.4% versus 66.7%, p=0.047). Associations were found between the incidence of an undesired postoperative outcome and higher TUG (OR 1.42, p=0.037), lower VO2 at AT (OR 0.75, p=0.052) and higher BMI (OR 1.20, p=0.067). In multivariate analysis the VO2 at AT showed to be the only independent and nearly significant predictor. CONCLUSION Our study showed a moderate relationship between cardiorespiratory fitness and functional mobility. The TUG test therefore did not sufficiently predict cardiorespiratory fitness in elderly patients requiring colorectal surgery. CPET remained superior for stratifying patients at risk for impaired short-term postoperative outcome. Preoperative physical programs for high risk patients may be beneficial in order to reduce complications and speed up postoperative recovery.

Item Type:	Thesis (Thesis)
Supervisor name:	SUPERVISOR: and BUIS, DR. C.I. SURGEON and LOCATION: SURGERY DEPARTMENT MEDICAL SPECTRUM TWENTE ENSCHED and UNIVERSITY MEDICAL CENTER GRONINGEN
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:07
Last Modified:	25 Jun 2020 11:07
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2691

Actions (login required)

View Item