Abstract
BackgroundThe use of preoperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative outcomes is increasingly prevalent. CPET-derived information enables personalised perioperative care and enhances shared decision-making. Sex-related differences in physical fitness are reported in non-perioperative literature. However, little attention has been paid to sex-related differences in the context of perioperative CPET.AimWe explored differences in the physical fitness variables reported in a recently published multi-centre study investigating CPET before colorectal surgery. We also report the inclusion rate of females in published perioperative CPET cohorts that are shaping guidelines and clinical practice.MethodsWe performed a post hoc analysis of the trial data of 703 patients who underwent CPET prior to major elective colorectal surgery. We also summarised the female inclusion rate in peer-reviewed published reports of perioperative CPET.ResultsFitness assessed using commonly used perioperative CPET variables—oxygen consumption at anaerobic threshold (AT) and peak exercise—was significantly higher in males than in females both before and after correction for body weight. In studies contributing to the development of perioperative CPET, 68.5% of the participants were male.ConclusionTo our knowledge, this is the first study to describe differences between males and females in CPET variables used in a perioperative setting. Furthermore, there is a substantial difference between the inclusion rates of males and females in this field. These findings require validation in larger cohorts and may have significant implications for both sexes in the application of CPET in the perioperative setting.
Highlights
The use of clinical exercise testing is increasingly prevalent in the field of perioperative risk assessment (Huddart et al, 2013)
In studies contributing to the development of perioperative cardiopulmonary exercise testing (CPET), 68.5% of the participants were male
Conclusions and recommendations we recognise the limitations of the results described above, which are observational in nature, we did find a striking difference between the aerobic capacity of male and female surgical candidates in our study, that has previously gone underreported
Summary
The use of clinical exercise testing is increasingly prevalent in the field of perioperative risk assessment (Huddart et al, 2013). Cardiopulmonary exercise testing (CPET) is the most objective and precise means of assessing physical fitness in surgical candidates and has found utility for the prediction and stratification of surgical risk in various clinical fields including thoracic, vascular and abdominal surgery (Moran et al, 2016; Tew et al, 2018; Goodyear et al, 2013; Brunelli et al, 2009). Substantial progress is being made in the development of such guidelines for perioperative physicians, these guidelines have not addressed sex-related differences in exercise capacity or other CPET-derived variables (Levett et al, 2018). It is known that clinical risk profiles and the response to surgical injury differ between males and females. Little attention has been paid to sex-related differences in the context of perioperative CPET
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