Peak Oxygen Consumption During Cardiopulmonary Exercise Test Improves Risk Stratification in Candidates to Major Lung Resection

Background: The objective of this investigation was to assess the association of peak oxygen consumption ((v) over doto(2)) with postoperative outcome in a prospective cohort of patients undergoing major lung resection for the treatment of lung cancer. Methods: Preoperative symptom-limited cardiopulmonary exercise testing (CPET) performed using cycle ergometry was conducted in 204 consecutive patients who had undergone pulmonary lobectomy or pneumonectomy. Peak (v) over doto(2) was tested for possible association with postoperative cardiopulmonary complications and mortality. Logistic regression analysis, validated by a bootstrap analysis, was used to adjust for the effect of other perioperative factors. The role of peak (v) over doto(2) in stratifying the surgical risk was further assessed in different groups of patients 9 subdivided according to their cardiorespiratory status. Results: Logistic regression showed that peak (v) over doto(2) was an independent and reliable predictor of pulmonary complications (p = 0.04). All six deaths occurred in patients with a peak (v) over doto(2) of < 20 mL/kg/min (four deaths in patients with a peak (v) over doto(2), of < 12 mL/kg/min). The mortality rate in this high-risk group was 10-fold higher (4 of 30 patients; 13%) compared to those with higher peak (v) over doto(2) (p = 0.006). Compared to patients with a peak (v) over doto(2), of > 20 mL/kg/min, those with a peak (v) over doto(2) of < 12 mL/kg/min had 5-fold, 8-fold, 5-fold, and 13-fold higher rates, respectively, of total cardiopulmonary complications pulmonary complications, cardiac complications, and mortality. Conclusions: The present study supports a more liberal use of CPET before lung resection compared to the current guidelines since this test can help in stratifying the surgical risk and optimizing perioperative care. (CHEST 2009; 135:1260-1267)