A Comparison of Outcome in Patient With and Without Undergoing Cardiopulmonary Exercise Testing (CPET).

Background: Cardiopulmonary exercise testing (CPET) is a preoperative risk stratification tool providing an objective measure of fitness and functional capacity. There is however little evidence on the use of this compared to non-physiological test in vascular surgery despite its current use. This study investigates whether CPET perioperatively has value alongside non-physiological testing for patients undergoing elective open abdominal aortic aneurysm (AAA) repair.

Method: Retrospective data was collected at 2 vascular centres between 2015-2019 in a CPET centre vs non-CPET centre in patients undergoing elective AAA repair. Outcomes measured included: length of stay in an intensive care unit (ICU); total length of stay; post-operative complications and acute kidney injury (AKI). Statistical analysis was performed using IBM SPSS software.

Results: There were 38 patients at each centre. The mean duration of stay in ICU for patients in CPET centre was 2.5 ± 2.13 days whilst in non-CPET centre it was 3.68 ± 4.08 days (P = 0.05). The mean duration of stay in ICU and total length of stay was significantly shorter in CPET centre (P = 0.05 and P = 0.015 respectively). Mortality in CPET centre was 2.63% and 5.26% in non-CPET centre (not significant). The number of patients developing AKI post-operatively was 13.61% in CPET vs 28.95% in non-CPET centre.

Conclusion: CPET tested patients have statistically significant lower length of total and ICU stay compared to non-CPET patients. CPET is therefore a useful adjunct in selecting patients for open surgery compared to non-physiological testing. This study provides some evidence on the use of this routinely but not validated assessment tool in aortic aneurysm repair.