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To develop an integrated strategy for the identification and subsequent management
of high-risk patients in order to reduce both morbidity and mortality.
Prospective consecutive series in which all patients underwent cardiopulmonary exercise
CPX laboratory and level 3 ICU and high-dependency unit (HDU) of a metropolitan teaching
Five hundred forty-eight patients >60 years of age (or younger with known cardiopulmonary
disease) scheduled for major intra-abdominal surgery.
The patients were assigned to one of three management strategies (ICU, HDU, or ward)
based on the anaerobic threshold (deltaT) and ECG evidence of myocardial ischemia
as determined by CPX testing that was performed as part of the presurgery evaluation,
and by the expected oxygen demand stress of the surgical procedure.
Overall mortality was 3.9%. Forty-three percent of deaths were attributed to poor
cardiopulmonary function, as detected preoperatively. There were no deaths related
to cardiopulmonary complications in any patient deemed fit for major abdominal surgery
and ward management, as determined by CPX testing.
In elderly patients undergoing major intra-abdominal surgery, the AT, as determined
by CPX testing, is an excellent predictor of mortality from cardiopulmonary causes
in the postoperative period. Preoperative screening using CPX testing allowed the
identification of high-risk patients and the appropriate selection of perioperative