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dc.contributor.authorStruthers, Ren
dc.contributor.authorErasmus, Pen
dc.contributor.authorHolmes, Ken
dc.contributor.authorWarman, Pen
dc.contributor.authorCollingwood, Aen
dc.contributor.authorSneyd, JRen

BACKGROUND: Morbidity and mortality are higher in patients with poor preoperative cardiorespiratory reserve. This study aimed to ascertain fitness and therefore risk in elective patients, comparing three measures: Duke Activity Status Index (DASI) questionnaire, incremental shuttle walk test (ISWT), and cycle cardiopulmonary exercise testing (CPET). We looked for correlation between the measures and for thresholds on the questionnaire or shuttle test which could identify fit patients and render CPET unnecessary. METHODS: A prospective cohort trial of 50 patients having intra-abdominal surgery. Each performed DASI, ISWT, and CPET during a single visit to the hospital. RESULTS: There was a significant correlation between measured oxygen consumption and both ISWT and DASI. Receiver operator curve showed both the shuttle walk test and the DASI are sensitive and specific predictors of VO(2)peak >15 ml O(2) kg(-1) min(-1) and anaerobic threshold (AT) >11 ml O(2) kg(-1) min(-1). Thirty-two patients would be considered lower risk, having achieved both VO(2)peak and AT cut-offs. Setting an ISWT threshold of 360 m identified 13 of the lower risk patients [positive predictive value (PPV) 1.0, negative predictive value (NPV) 0.49]. Setting a DASI threshold score of 46 identified nine lower risk patients (PPV 1.0, NPV 0.44). CONCLUSIONS: We found a significant correlation between the tests. However, many patients with poor questionnaire scores or shuttle walks had satisfactory CPET results. Hence, the ability of either simple test to determine risk in a heterogeneous surgical population is poor. CPET provides an objective measurement of cardiopulmonary fitness; however, evidence for this information improving patient outcome is limited and requires further research.

dc.format.extent774 - 780en
dc.subjectAged, 80 and overen
dc.subjectEpidemiologic Methodsen
dc.subjectExercise Testen
dc.subjectMiddle Ageden
dc.subjectOxygen Consumptionen
dc.subjectPreoperative Careen
dc.subjectTreatment Outcomeen
dc.titleAssessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients.en
dc.typeJournal Article
plymouth.journalBr J Anaesthen
plymouth.organisational-group/Plymouth/00 Groups by role
plymouth.organisational-group/Plymouth/00 Groups by role/Professional Services staff
plymouth.organisational-group/Plymouth/Faculty of Medicine and Dentistry
plymouth.organisational-group/Plymouth/Faculty of Medicine and Dentistry/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA01 Clinical Medicine
dc.rights.embargoperiodNot knownen
rioxxterms.typeJournal Article/Reviewen

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