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Bailey DM, Rose GA, O'Donovan D, Locker D, Appadurai IR, Davies RG, Whiston RJ, Bashir M, Lewis MH, Williams IM. Retroperitoneal Compared to Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair Is Associated with Reduced Systemic Inflammation and Postoperative Morbidity. AORTA (STAMFORD, CONN.) 2022; 10:225-234. [PMID: 36539114 PMCID: PMC9767756 DOI: 10.1055/s-0042-1749173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In the United Kingdom, the most common surgical approach for repair of open abdominal aortic aneurysms (AAAs) is transperitoneal (TP). However, retroperitoneal (RP) approach is favored in those with more complex vascular anatomy often requiring a cross-clamp on the aorta superior to the renal arteries. This study compared these approaches in patients matched on all major demographic, comorbid, anatomic, and physiological variables. METHODS Fifty-seven patients (TP: n = 24; RP: n = 33) unsuitable for endovascular aneurysm repair underwent preoperative cardiopulmonary exercise testing prior to open AAA repair. The surgical approach undertaken was dictated by individual surgeon preference. Postoperative mortality, complications, and length of hospital stay (LoS) were recorded. Patients were further stratified according to infrarenal (IR) or suprarenal/supraceliac (SR/SC) surgical clamping. Systemic inflammation (C-reactive protein) and renal function (serum creatinine and estimated glomerular filtration rate) were recorded. RESULTS Twenty-three (96%) of TP patients only required an IR clamp compared with 12 (36%) in the RP group. Postoperative systemic inflammation was lower in RP patients (p = 0.002 vs. TP) and fewer reported pulmonary/gastrointestinal complications whereas renal impairment was more marked in those receiving SR/SC clamps (p < 0.001 vs. IR clamp). RP patients were defined by lower LoS (p = 0.001), while mid-/long-term mortality was low/comparable with TP, resulting in considerable cost savings. CONCLUSION Despite the demands of more complicated vascular anatomy, the clinical and economic benefits highlighted by these findings justify the more routine adoption of the RP approach for complex AAA repair.
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Affiliation(s)
- Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Address for correspondence Damian Miles Bailey, PhD Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South WalesAlfred Russel Wallace Building, CF37 4ATUnited Kingdom
| | - George A. Rose
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Daniel O'Donovan
- Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Dafydd Locker
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Ian R. Appadurai
- Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Richard G. Davies
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Richard J. Whiston
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Mohamad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Michael H. Lewis
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Ian M. Williams
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
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2
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Bailey DM, Rose GA, Berg R, Davies RG, Appadurai IR, Lewis MH, Williams IM. Cardiorespiratory fitness fails to predict short-term postoperative mortality in patients undergoing elective open surgery for abdominal aortic aneurysm. Ann R Coll Surg Engl 2020; 102:536-539. [PMID: 32538122 DOI: 10.1308/rcsann.2020.0120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Preoperative cardiopulmonary exercise testing aids surgical risk stratification and is an established predictor of mid- to long-term survival in patients undergoing elective open abdominal aortic aneurysm repair. Whether cardiopulmonary exercise testing also predicts 30-day mortality in this population remains to be established. MATERIALS AND METHODS Data for 109 patients (mean age 72 years) who underwent cardiopulmonary exercise testing to assess risk for surgical abdominal aortic aneurysm repair was analysed. Patients were classified according to cardiopulmonary fitness as fit (peak oxygen uptake ≥ 15ml O2.kg-1.min-1) or unfit (peak oxygen uptake less than 15ml O2.kg-1.min-1) and further stratified according to clamp position (infrarenal or suprarenal). Between-group postoperative outcomes were compared for in-hospital 30-day mortality, postoperative morbidity scale scores (day 5) and hospital length of stay. RESULTS Seventy-nine patients underwent open surgery and 30 patients were treated conservatively. No deaths were recorded at 30 days post-surgery. Unfit patients with infrarenal clamping exhibited higher postoperative morbidity scale scores (64% vs 26%) and longer length of stay (four days) than fit patients (p < 0.05). Conversely, with suprarenal clamping, postoperative morbidity scale scores were similar and length of stay longer (three days) in fit compared with unfit patients (p < 0.05). DISCUSSION AND CONCLUSION Preoperative fitness level defined by peak oxygen uptake failed to identify patients at risk of 30-day mortality when undergoing elective abdominal aortic aneurysm repair. Postoperative morbidity and length of stay in patients with suprarenal clamping was high independent of cardiopulmonary fitness. These findings suggest that cardiopulmonary exercise testing may be a useful predictor of complications following infrarenal rather than suprarenal clamping but may not be a good predictor of 30-day mortality.
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Affiliation(s)
- D M Bailey
- University of South Wales, Pontypridd, UK
| | - G A Rose
- University of South Wales, Pontypridd, UK
| | - Rmg Berg
- University of South Wales, Pontypridd, UK.,University of Copenhagen, Denmark.,Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - R G Davies
- University of South Wales, Pontypridd, UK.,Department of Anaesthetics, University Hospital of Wales, Cardiff, Wales, UK
| | - I R Appadurai
- Department of Anaesthetics, University Hospital of Wales, Cardiff, Wales, UK
| | - M H Lewis
- University of South Wales, Pontypridd, UK
| | - I M Williams
- Department of Surgery, University Hospital of Wales, Cardiff, Wales, UK
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Dawkins C, Hollingsworth AC, Milburn S, Walker P, Cheesman M, Mofidi R. Is gender still a risk factor for mortality in patients who undergo elective repair of abdominal aortic aneurysms? Experience of a single center. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:713-719. [PMID: 32241090 DOI: 10.23736/s0021-9509.20.11196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Vascular Services Quality Improvement Program (VSQIP) was introduced to reduce mortality from elective repair of AAA in the UK. This study examines the differences in perioperative mortality and postoperative survival between men and women following elective repair of AAAs in the 10 years after implementation of the (VSQIP). METHODS Consecutive patients who underwent elective repair of AAA between 1st January 2008 and 31st March 2018 were included. All patients were assessed using the nationally agreed VSQIP pathway which involved cardiopulmonary exercise testing as well as contrast enhanced CT scan of aorta and multidisciplinary assessment to plan each treatment. CT scans were examined to assess the morphology of AAA. Patients were stratified by age, gender, AAA morphology and preoperative anaerobic threshold. Postoperative survival was assessed using Kaplan-Meier analysis. Cox regression analysis was used to determine predictors of postoperative mortality. RESULTS A total of 702 patients underwent elective repair of AAA of whom 632 were men and 70 were women. The mean age of study cohort was 73.5±7.3 years and mean AAA diameter was 62±9.9 mm. Two hundred and forty-four patients underwent open repair, 402 underwent infrarenal endovascular aneurysm repair (EVAR) and 56 underwent complex EVAR with perioperative and 30-day mortality of 1.13%. No significant difference was observed in perioperative/30-day mortality between men and women (χ2=0.06, P=0.81). Anaerobic threshold <8 (HR=0.68 [95% CI: 0.51-0.92]), complex aneurysm morphology (HR=1.7 [95% CI: 1.39-2.19]) risk category (HR=1.89 [95% CI: 1.48-2.42]) and patients age (HR=1.41 [95% CI: 1.13-1.89]) were independent risk factor for mortality following repair of AAA, whilst female gender (HR=0.89 [95% CI: 0.54-1.48]) and AAA size (HR=1.01 [95% CI: 0.84-1.22]) were not. There was no difference in postoperative survival between men and women who underwent elective repair of AAA (Log rank: 1.82, P=0.61). CONCLUSIONS Following the implementation of VSQIP female gender is no longer a significant risk factor for perioperative mortality or reduced survival following elective repair of large asymptomatic AAA.
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Affiliation(s)
- Claire Dawkins
- Department of Vascular Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Simon Milburn
- Department of Interventional Radiology, James Cook University Hospital, Middlesbrough, UK
| | - Paul Walker
- Department of Vascular Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Matthew Cheesman
- Department of Anesthesia, James Cook University Hospital, Middlesbrough, UK
| | - Reza Mofidi
- Department of Vascular Surgery, James Cook University Hospital, Middlesbrough, UK -
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Czobor NR, Lehot JJ, Holndonner-Kirst E, Tully PJ, Gal J, Szekely A. Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence. Ther Clin Risk Manag 2019; 15:1217-1232. [PMID: 31802876 PMCID: PMC6802734 DOI: 10.2147/tcrm.s217717] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/01/2019] [Indexed: 12/13/2022] Open
Abstract
Frailty is presumably associated with an elevated risk of postoperative mortality and adverse outcome in vascular surgery patients. The aim of our review was to identify possible methods for risk assessment and prehabilitation in order to improve recovery and postoperative outcome. The literature search was performed via PubMed, Embase, OvidSP, and the Cochrane Library. We collected papers published in peer-reviewed journals between 2001 and 2018. The selection criterion was the relationship between vascular surgery, frailty and postoperative outcome or mortality. A total number of 52 publications were included. Frailty increases the risk of non-home discharge independently of presence or absence of postoperative complications and it is related to a higher 30-day mortality and major morbidity. The modified Frailty Index showed significant association with elevated risk for post-interventional stroke, myocardial infarction, prolonged in-hospital stays and higher readmission rates. When adjusted for comorbidity and surgery type, frailty seems to impact medium-term survival (within 2 years). Preoperative physical exercising, avoidance of hypalbuminemia, psychological and cognitive training, maintenance of muscle strength, adequate perioperative nutrition, and management of smoking behaviours are leading to a reduced length of stay and a decreased incidence of readmission rate, thus improving the effectiveness of early rehabilitation. Pre-frailty is a dynamically changing state of the patient, capable of deteriorating or improving over time. With goal-directed preoperative interventions, the decline can be prevented.
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Affiliation(s)
- Nikoletta Rahel Czobor
- Medical Centre of Hungarian Defense Forces, Department of Anesthesiology and Intensive Care, Budapest, Hungary.,Semmelweis University, School of Doctoral Studies, Budapest, Hungary
| | - Jean-Jacques Lehot
- Claude-Bernard University, Health Services and Performance Research Lab (EA 7425 HESPER), Lyon, France.,Hôpital Neurologique Pierre Wertheimer, Department of Neuroanesthesia and Intensive Care, Hospices Civils de Lyon, Lyon, France
| | - Eniko Holndonner-Kirst
- Medical Centre of Hungarian Defense Forces, Department of Anesthesiology and Intensive Care, Budapest, Hungary
| | - Phillip J Tully
- University of Adelaide, Freemasons Foundation Centre for Men's Health, Adelaide, Australia
| | - Janos Gal
- Semmelweis University, Department of Anesthesiology and Intensive Care, Budapest, Hungary
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Care, Budapest, Hungary.,Semmelweis University, Heart and Vascular Center of Városmajor, Budapest, Hungary
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5
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Dawkins C, Hollingsworth AC, Walker P, Milburn S, Danjoux G, Cheesman M, Mofidi R. Anaerobic threshold as an independent predictor of mid-term survival following elective endovascular repair of abdominal aortic aneurysm. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:596-603. [PMID: 31599146 DOI: 10.23736/s0021-9509.19.11052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to examine the value preoperative AT as predictor of postoperative survival in patients who underwent elective EVAR for repair of asymptomatic AAA. METHODS Consecutive patients who underwent elective EVAR between 2008 and 2018 were analyzed. Cardiopulmonary exercise testing was performed. Perioperative 30-day mortality was compared between patients who had AT ≥8 mL/kg/min and those with AT<8 mL/kg/min. Risk factors for postoperative survival following EVAR were examined using Cox's regression analysis. RESULTS Between 1<sup>st</sup> January 2008 and 31<sup>st</sup> December 2017, 430 patients underwent elective EVAR (standard device: N.=374, fenestrated/branched: N.=56); their median age was 76 years (range: 53-91 years), median AT was 9.3 (range: 5.4-16.1), and 30-day mortality was 0.9%. These patients were followed up for a median of 1630 days. There was no significant difference in perioperative 30-day mortality between patients who had AT≥8 and those who had AT<8 (χ<sup>2</sup>=1.56, P=0.22). Age (HR=1.51 [CI: 1.07-1.99], P<0.05) and AT (HR=0.59 [CI: 0.45-0.76], P=0.0003) were predictors of reduced postoperative survival following elective EVAR whereas gender (HR=0.75 [CI: 0.4-1.4], P=0.37), AAA diameter (HR=0.95 [CI: 0.77-1.16], P=0.6), and AAA morphology (HR=1.23 [CI: 0.68-1.76], P=0.95) were not. CONCLUSIONS Anaerobic threshold is an independent predictor of prolonged survival following elective EVAR and can be used to identify patients who receive most benefit from elective EVAR.
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Affiliation(s)
- Claire Dawkins
- Department of Vascular Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Paul Walker
- Department of Interventional Radiology, James Cook University Hospital, Middlesbrough, UK
| | - Simon Milburn
- Department of Interventional Radiology, James Cook University Hospital, Middlesbrough, UK
| | - Gerard Danjoux
- Department of Anesthesia, James Cook University Hospital, Middlesbrough, UK
| | - Matthew Cheesman
- Department of Anesthesia, James Cook University Hospital, Middlesbrough, UK
| | - Reza Mofidi
- Department of Vascular Surgery, James Cook University Hospital, Middlesbrough, UK -
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6
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Harwood AE, Pymer S, Hitchman L, Totty J, Wallace T, Smith GE, Carradice D, Carroll S, Chetter IC. The Intrarater and Interrater Reliability of Measures Derived from Cardiopulmonary Exercise Testing in Patients with Abdominal Aortic Aneurysms. Ann Vasc Surg 2019; 56:175-182. [DOI: 10.1016/j.avsg.2018.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 10/27/2022]
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Rose GA, Davies RG, Appadurai IR, Lewis WG, Cho JS, Lewis MH, Williams IM, Bailey DM. Cardiorespiratory fitness is impaired and predicts mid-term postoperative survival in patients with abdominal aortic aneurysm disease. Exp Physiol 2018; 103:1505-1512. [PMID: 30255553 DOI: 10.1113/ep087092] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/25/2018] [Indexed: 12/30/2022]
Abstract
NEW FINDINGS What is the central question of this study? To what extent cardiorespiratory fitness is impaired in patients with abdominal aortic aneurysmal (AAA) disease and corresponding implications for postoperative survival requires further investigation. What is the main finding and its importance? Cardiorespiratory fitness is impaired in patients with AAA disease. Patients with peak oxygen uptake of <13.1 ml O2 kg-1 min-1 and ventilatory equivalent for carbon dioxide at anaerobic threshold ≥34 are associated with increased risk of postoperative mortality at 2 years. These findings demonstrate that cardiorespiratory fitness can predict mid-term postoperative survival in AAA patients, which may help to direct care provision. ABSTRACT Preoperative cardiopulmonary exercise testing is a standard assessment of cardiorespiratory fitness (CRF) and risk stratification. However, to what extent CRF is impaired in patients undergoing surgical repair of abdominal aortic aneurysm (AAA) disease and the corresponding implications for postoperative outcome requires further investigation. We measured CRF during an incremental exercise test to exhaustion using online respiratory gas analysis in patients with AAA disease (n = 124, aged 72 ± 7 years) and healthy sedentary control subjects (n = 104, aged 70 ± 7 years). Postoperative survival was examined for association with CRF, and threshold values were calculated for independent predictors of mortality. Patients who underwent preoperative cardiopulmonary exercise testing before surgical repair had lower CRF [age-adjusted mean difference of 12.5 ml O2 kg-1 min-1 for peak oxygen uptake ( V ̇ O 2 peak ), P < 0.001 versus control subjects]. After multivariable analysis, both V ̇ O 2 peak and the ventilatory equivalent for carbon dioxide at anaerobic threshold ( V ̇ E / V ̇ C O 2 - AT ) were independent predictors of mid-term postoperative survival (2 years). Hazard ratios of 5.27 (95% confidence interval 1.62-17.14, P = 0.006) and 3.26 (95% confidence interval 1.00-10.59, P = 0.049) were observed for V ̇ O 2 peak < 13.1 ml O2 kg-1 min-1 and V ̇ E / V ̇ C O 2 - AT ≥ 34, respectively. Thus, CRF is lower in patients with AAA, and those with a V ̇ O 2 peak < 13.1 ml O2 kg-1 min-1 and V ̇ E / V ̇ C O 2 - AT ≥ 34 are associated with a markedly increased risk of postoperative mortality. Collectively, our findings demonstrate that CRF can predict mid-term postoperative survival in AAA patients, which may help to direct care provision.
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Affiliation(s)
- G. A. Rose
- Faculty of Life Sciences and Education; University of South Wales; Pontypridd UK
| | - R. G. Davies
- Department of Anaesthetics; University Hospital of Wales; Cardiff UK
| | - I. R. Appadurai
- Department of Anaesthetics; University Hospital of Wales; Cardiff UK
| | - W. G. Lewis
- Department of Surgery; University Hospital of Wales; Cardiff UK
| | - J. S. Cho
- Department of Cardiovascular Surgery; Kings College London; London UK
| | - M. H. Lewis
- Faculty of Life Sciences and Education; University of South Wales; Pontypridd UK
| | - I. M. Williams
- Department of Surgery; University Hospital of Wales; Cardiff UK
| | - D. M. Bailey
- Faculty of Life Sciences and Education; University of South Wales; Pontypridd UK
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Durrand JW, Wagstaff K, Kasim A, Cawthorn L, Danjoux GR, Kothmann E. Reliability of repeated arm-crank cardiopulmonary exercise tests in patients with small abdominal aortic aneurysm. Anaesthesia 2018; 73:967-971. [PMID: 29727012 DOI: 10.1111/anae.14312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Abstract
Arm-crank ergometry may be useful in patients unable to pedal, for instance due to peripheral arterial disease. Twenty participants with small abdominal aortic aneurysm undertook two serial arm-crank tests and then a pedal test, four of whom had indeterminate anaerobic thresholds, precluding analysis. The mean (SD) peak arm and leg oxygen consumptions in 16 participants were 13.71 (2.62) ml.kg-1 .min-1 and 16.82 (4.44) ml.kg-1 .min-1 , with mean (SD) individual differences of 3.11 (2.48) ml.kg-1 .min-1 , p = 0.0001. The respective values at the anaerobic thresholds were 7.83 (1.58) ml O2 .kg-1 .min-1 and 10.09 (3.15) ml O2 .kg-1 .min-1 , with mean (SD) individual differences of 2.26 (2.34) ml O2 .kg-1 .min-1 , p = 0.0001. The correlation coefficients (95%CI) for peak oxygen consumption and anaerobic threshold were 0.88 (0.62-1.0) and 0.70 (0.32-1.0). There were no significant differences in serial arm-crank tests, with intracluster correlations (95%CI) of 0.87 (0.86-0.88) and 0.65 (0.61-0.69) for peak oxygen consumption and anaerobic threshold, respectively.
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Affiliation(s)
- J W Durrand
- Northern School of Anaesthesia and Intensive Care Medicine, Health Education North East, Newcastle-upon-Tyne, UK
| | - K Wagstaff
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK
| | - L Cawthorn
- Department of Anaesthesia, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - G R Danjoux
- Department of Anaesthesia, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.,Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - E Kothmann
- Department of Anaesthesia, North Tees and Hartlepool NHS Foundation Trust, Middlesbrough, UK
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9
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Richardson K, Levett D, Jack S, Grocott M. Fit for surgery? Perspectives on preoperative exercise testing and training. Br J Anaesth 2017; 119:i34-i43. [DOI: 10.1093/bja/aex393] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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10
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Tew GA, Batterham AM, Colling K, Gray J, Kerr K, Kothmann E, Nawaz S, Weston M, Yates D, Danjoux G. Randomized feasibility trial of high-intensity interval training before elective abdominal aortic aneurysm repair. Br J Surg 2017; 104:1791-1801. [DOI: 10.1002/bjs.10669] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/25/2017] [Accepted: 07/11/2017] [Indexed: 12/23/2022]
Abstract
Abstract
Background
This study assessed the feasibility of a preoperative high-intensity interval training (HIT) programme in patients awaiting elective abdominal aortic aneurysm repair.
Methods
In this feasibility trial, participants were allocated by minimization to preoperative HIT or usual care. Patients in the HIT group were offered three exercise sessions per week for 4 weeks, and weekly maintenance sessions if surgery was delayed. Feasibility and acceptability outcomes were: rates of screening, eligibility, recruitment, retention, outcome completion, adverse events and adherence to exercise. Data on exercise enjoyment (Physical Activity Enjoyment Scale, PACES), cardiorespiratory fitness (anaerobic threshold and peak oxygen uptake), quality of life, postoperative morbidity and mortality, duration of hospital stay and healthcare utilization were also collected.
Results
Twenty-seven patients were allocated to HIT and 26 to usual care (controls). Screening, eligibility, recruitment, retention and outcome completion rates were 100 per cent (556 of 556), 43·2 per cent (240 of 556), 22·1 per cent (53 of 240), 91 per cent (48 of 53) and 79–92 per cent respectively. The overall exercise session attendance rate was 75·8 per cent (276 of 364), and the mean(s.d.) PACES score after the programme was 98(19) (‘enjoyable’); however, the intensity of exercise was generally lower than intended. The mean anaerobic threshold after exercise training (adjusted for baseline score and minimization variables) was 11·7 ml per kg per min in the exercise group and 11·4 ml per kg per min in controls (difference 0·3 (95 per cent c.i. –0·4 to 1·1) ml per kg per min). There were trivial-to-small differences in postoperative clinical and patient-reported outcomes between the exercise and control groups.
Conclusion
Despite the intensity of exercise being generally lower than intended, the findings support the feasibility and acceptability of both preoperative HIT and the trial procedures. A definitive trial is warranted. Registration number: ISRCTN09433624 (https://www.isrctn.com/).
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Affiliation(s)
- G A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - A M Batterham
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - K Colling
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - J Gray
- Department of Nursing, Midwifery and Healthcare, Northumbria University, Newcastle upon Tyne, UK
| | - K Kerr
- Department of Anaesthesia, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - E Kothmann
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - S Nawaz
- Sheffield Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Weston
- Department of Psychology, Sport and Exercise, School of Social Sciences, Business and Law, Teesside University, Middlesbrough, UK
| | - D Yates
- Department of Anaesthesia, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - G Danjoux
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
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