PenQuest Volume 3, Number 1

The Table of Contents for this Volume: Untitled by R. Bruce Warner Seeing the Unseen by Sharon Gresham Untitled by Helen Hagadorn Untitled by Steve Balunan Happy Holidays by Donna Kaluzniak River-walking, Night-talking by William Slaughter Ribbon of Light by Judith Mizrahi Love in Parentheses by Sharon Gresham Untitled by Steve Balunan Protohistory by Patricia Kraft Untitled by Bruce Abbey Untitled by Rick Wagner Thanatopsis by Pat Kraft Untitled by Sue Hightower Untitled by Rick Wagner Conversations of a Woman by Sharon Gresham Thur, Fri, Sat, at Mr. B\u27s by Patricia Kraft Untitled by Rick Wagner Untitled by Cindy Carlisle Untitled by Win Lyons Untitled by Cindy Carlisle Untitled by Modesta Matthews Untitled by James Tutten A Light at Mill Pond Crossing by Joe Palmer Untitled by Rick Wagner Two People by Kathleen Gay Untitled by Rick Wagner American Dream (Russian Version) by William Slaughter Untitled by Judith Mizrahi Untitled by Linda Willco

Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study

BACKGROUND: Postoperative complications are associated with reduced fitness. Cardiopulmonary exercise testing (CPET) has been used in risk stratification. We investigated the relationship between preoperative CPET and in-hospital morbidity in major colonic surgery.METHODS: We prospectively studied 198 patients undergoing major colonic surgery (excluding neoadjuvant cancer therapy), performing preoperative CPET (reported blind to clinical state), and recording morbidity (assessed blind to CPET), postoperative outcome, and length of stay.RESULTS: Of 198 patients, 62 were excluded: 11 had emergency surgery, 25 had no surgery, 23 had incomplete data, and three were unable to perform CPET. One hundred and thirty-six (89 males, 47 females) were available for analysis. The median age was 71 [inter-quartile range (IQR) 62-77] yr. Sixty-five patients (48%) had a complication at day 5 after operation. Measurements significantly lower in patients with complications than those without were O2 uptake () at estimated lactate threshold () [median 9.9 (IQR 8.3-12.7) vs 11.2 (9.5-14.2) ml kg-1 min-1, P&lt;0.01], at peak [15.2 (12.6-18.1) vs 17.2 (13.7-22.5) ml kg-1 min-1, P=0.01], and ventilatory equivalent for CO2 (/) at [31.3 (28.0-34.8) vs 33.9 (30.0-39.1), P&lt;0.01]. A final multivariable logistic regression model contained at {one-point change odds ratio (OR) 0.77 [95% confidence interval (CI) 0.66-0.89], P&lt;0.0005; two-point change OR 0.61 (0.46-0.81) and gender [OR 4.42 (1.78-9.88), P=0.001]}, and was reasonably able to discriminate those with and without complications (AUC 0.71, CI 0.62-0.80, 68% sensitivity, 65% specificity).CONCLUSIONS: CPET variables are associated with postoperative morbidity. A multivariable model with at and gender discriminates those with complications after colonic surgery.<br/

Pre-operative cardiopulmonary exercise testing predicts adverse post-operative events and non-progression to adjuvant therapy after major pancreatic surgery

Background: Surgery followed by chemotherapy is the primary modality of cure for patients with resectable pancreatic cancer but is associated with significant morbidity. The aim of the present study was to evaluate the role of cardiopulmonary exercise testing (CPET) in predicting post-operative adverse events and fitness for chemotherapy after major pancreatic surgery.&lt;p&gt;&lt;/p&gt; Methods: Patients who underwent a pancreaticoduodenectomy or total pancreatectomy for pancreatic head lesions and had undergone pre-operative CPET were included in this retrospective study. Data on patient demographics, comorbidity and results of pre-operative evaluation were collected. Post-operative adverse events, hospital stay and receipt of adjuvant therapy were outcome measures.&lt;p&gt;&lt;/p&gt; Results: One hundred patients were included. Patients with an anaerobic threshold less than 10 ml/kg/min had a significantly greater incidence of a post-operative pancreatic fistula [International Study Group for Pancreatic Surgery (ISGPS) Grades A–C, 35.4% versus 16%, P = 0.028] and major intra-abdominal abscesses [Clavien–Dindo (CD) Grades III–V, 22.4% versus 7.8%, P = 0.042] and were less likely to receive adjuvant therapy [hazard ratio (HR) 6.30, 95% confidence interval (CI) 1.25–31.75, P = 0.026]. A low anaerobic threshold was also associated with a prolonged hospital stay (median 20 versus 14 days, P = 0.005) but not with other adverse events.&lt;p&gt;&lt;/p&gt; Discussion: CPET predicts a post-operative pancreatic fistula, major intra-abdominal abscesses as well as length of hospital stay after major pancreatic surgery. Patients with a low anaerobic threshold are less likely to receive adjuvant therapy.&lt;p&gt;&lt;/p&gt