Oxygen consumption (VO₂) is a core element of hemodynamic physiology and the metabolic counterpart to oxygen delivery. Modern anesthesia machines enable real-time intraoperative VO₂ estimation, yet its relationship with preoperative metabolic capacity, as characterized by cardiopulmonary exercise testing (CPET), has not been directly examined. This study analyzed preoperative CPET and intraoperative data from adult patients ≥ 20 undergoing lung resection under general anesthesia. Intraoperative VO₂ was estimated from minute ventilation and inspired and end-tidal oxygen fractions. Preoperative and intraoperative VO₂ were summarized, and associations between baseline VO₂ and intraoperative suppression were assessed. Data from 32 patients were analyzed. Preoperative VO₂ at rest, anaerobic threshold, and peak exercise were 1.6 ± 0.4, 5.1 ± 1.9, and 6.1 ± 1.7 metabolic equivalents (METs), respectively. The reduction from resting to intraoperative VO₂ (-29.0 ± 19.4%) showed a strong correlation with resting VO₂ (r = 0.770, p < 0.001). Consequently, regardless of preoperative resting VO₂, intraoperative VO₂ converged to a relatively narrow range, averaging 1.1 ± 0.2 METs. In patients undergoing lung resection, intraoperative VO₂ converged to approximately 1 MET under general anesthesia, largely independent of preoperative resting metabolism. The clinical implications of this observation remain unclear and warrant investigation in larger prospective studies incorporating concurrent measurements of oxygen delivery and clinical outcomes.

BackgroundIn patients with non-small cell lung cancer (NSCLC), postoperative pulmonary complications (PPCs) significantly increase morbidity and healthcare costs. To improve upon models based solely on static variables, this study aimed to develop a preoperative nomogram integrating cardiopulmonary exercise testing (CPET) parameters for predicting PPCs. The primary objective of this study was to develop a nomogram for predicting PPCs in NSCLC patients using preoperative CPET parameters combined with clinical variables, and to validate its discriminatory power and predictive.MethodsData, including clinical and CPET results, were collected from patients who underwent CPET before video-assisted thoracic surgery (VATS) at the Department of Thoracic Surgery, Xuzhou Central Hospital between August 2019 and November 2023. Independent risk factors for PPCs were identified through univariate and multivariate stepwise logistic regressions, and a nomogram prediction model was constructed. The model’s discriminatory power and accuracy were assessed using the concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and area under the curve (AUC) in the validation cohort.ResultsData from 607 patients were used to construct the nomogram, which included age, intraoperative blood loss, chronic obstructive pulmonary disease (COPD), peak oxygen uptake (VO2 peak), and the minute ventilation/carbon dioxide production (VE/VCO2) slope as predictive factors. The model demonstrated good discrimination and accuracy, with a C-index of 0.790 [95% confidence interval (95% CI): 0.743–0.853]. The calibration plot showed strong agreement between predicted and actual PPC probabilities. The ROC curve confirmed the model’s acceptable discrimination ability [area under the curve (AUC): 0.790, 95% CI: 0.605–0.829] in internal validation.ConclusionsThe predictive model for PPCs in patients with NSCLC exhibits strong discrimination and accuracy. It offers valuable support for clinicians in making informed treatment decisions.

Low preoperative cardiorespiratory fitness is associated with poorer functional and subjective recovery following hip or knee arthroplasty. The objective of this study was to evaluate the ability of simple, indirect assessment tools (the Duke Activity Status Index, daily step count, and timed up and go test) to estimate directly measured cardiorespiratory fitness and identify patients with low preoperative fitness (<15 mL/kg/min) among those with severe hip or knee osteoarthritis. Ninety-one patients with severe hip or knee osteoarthritis who were scheduled for total joint arthroplasty were recruited. Within 1 week before surgery, participants performed symptom-limited maximal cardiopulmonary exercise testing, the Duke Activity Status Index questionnaire, accelerometry to determine daily step count, and the timed up and go test. All three indirect tools provided strong estimates of peak oxygen consumption ( O2) (r2 ≥ 0.61). The Duke Activity Status Index slightly underestimated peak O2 by 0.9 mL/kg/min. All three metrics performed strongly in their ability to accurately identify patients without a peak O2 < 15 mL/kg/min; however, their accuracy to positively predict peak O2 > 15 mL/kg/min was only fair. These simple, practical, cost-effective tools have utility for estimating preoperative fitness to rule out low fitness. These tools could be used by perioperative clinicians for identifying patients who may not require preoperative cardiopulmonary exercise testing, thereby optimizing resource allocation.

ObjectiveTo explore the predictive value of key preoperative cardiopulmonary exercise testing (CPET) indicators for cardiopulmonary complications following thoracoscopic lung resection.MethodsPatients who underwent lung resection at the Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University were selected. Information was collected for patients who completed CPET using the incremental exercise protocol. Hospitalization information, postoperative complications and follow-up data were analyzed. Correlations between postoperative cardiopulmonary complications and preoperative CPET indices were analyzed to identify threshold values.ResultsAmong 376 thoracoscopic lung resection patients, 52 experienced at least one complication (13.8%). Comparison between the cardiopulmonary complications group (CCP) and no complications group (NCCP) revealed significant differences in age, extent of lung resection, and lymph node metastasis (P < 0.05). Core CPET indicators including peak heart rate (peak HR), peak oxygen uptake (peak VO2), peak VO2%pred, peak metabolic equivalent (peak MET), and maximal workload %pred were significantly lower in the CCP group (P < 0.05). The sensitivity and specificity of peak VO2%pred <70%, peak MET <5, and maximal workload %pred <80% all exceeded 60%, with negative predictive values surpassing 90%. Positive predictive values of peak VO2 < 15 mL/(min·kg), peak VO2%pred <60%, peak MET <4, and maximal workload %pred < 60% exceeded 30%. Using these cutoff values resulted in high diagnostic accuracy with odds ratios of 6.2, 4.0, 4.6, and 3.2, respectively.ConclusionKey preoperative CPET indicators effectively evaluate postoperative complication risk in thoracoscopic lung resection patients. Peak VO2, peak VO2%pred, peak MET, and maximal workload %pred are associated with postoperative cardiopulmonary complications.

Cardiopulmonary exercise testing (CPET) definition of peak oxygen uptake (VO2 peak) is useful in detecting patients with an acceptable risk for pneumonectomy. Nevertheless, postoperative mortality remains high. CPET allows to define another promising parameter, the ventilatory equivalent for carbon dioxide (VE/VCO2 slope) that could further improve patients selection. We tested the hypothesis that VE/VCO2 slope values may identify patients with a prohibitive risk. A retrospective analysis was performed on a cohort of patients who underwent pneumonectomy for lung cancer from March 2000 to March 2024. Postoperative morbidity and mortality were analysed according to VO2 peak and VE/CO2 slope values, and their risk was compared to patients who did not underwent preoperative CPET. Out of 277 patients who underwent pneumonectomy, preoperative CPET was performed in 144 cases (52%). In this group, mortality and respiratory morbidity were 4% and 15%, respectively, compared to 6% and 14% in patients who did not undergo preoperative CPET. VE/VCO2 slope would have been effective in detecting patients with prohibitive risk. In fact, using a slope cutoff value of 35, postoperative respiratory complications and mortality were 33% and 17%, respectively, in patients with a slope above 35 compared to 13% and 2% in those having a slope lower than 35 (P <.05). When VO2 peak suggests that pneumonectomy is feasible, values of VE/VCO2 slope deserve attention, as the risk becomes prohibitive when excessive CO2 retention is recorded during the test. The study suggested that a slope cut-off value of 35% may be useful to reduce postoperative adverse events.

Low Preoperative Exercise Tolerance Predicts Impaired Skeletal Muscle Recovery After Kidney Transplantation.

Can Preoperative Cardiopulmonary Exercise Testing (CPET) Predict Recurrent Colorectal Cancer: Short- and Long-Term follow-up?

Can Preoperative Cardiopulmonary Exercise Testing (CPET) Predict Recurrent Colorectal Cancer: Short- and Long-Term follow-up?

14 The impact of preoperative cardiopulmonary exercise testing on head and neck reconstruction in patients over 50: a retrospective data analysis

<h3>Background</h3> Cardiopulmonary exercise testing (CPET) has a pivotal role in preoperative evaluation of patients before lung cancer surgery. As surgical and perioperative practice and functional diagnostics continuously evolve, it may be time to reevaluate and refine the use of CPET in this setting. <h3>Research Question</h3> Can risk assessment with CPET before lung cancer surgery be improved by combining 2 established CPET variables (percent predicted peak oxygen uptake [Vo₂peak], and ventilatory efficiency, measured by minute ventilation [<mml:math><mml:mrow><mml:mi>V</mml:mi><mml:mo>˙</mml:mo><mml:mi>E</mml:mi></mml:mrow></mml:math>]/carbon dioxide elimination [Vco₂] slope) while using recently suggested optimal threshold values for these variables? <h3>Study Design and Methods</h3> Single-center, retrospective analysis of 208 patients with lung cancer who underwent preoperative CPET in 2008 to 2020. The main outcome was any major pulmonary complication (MPC) or death within 30 days of surgery. We combined previously suggested threshold values of percent predicted Vo₂peak and <mml:math><mml:mrow><mml:mi>V</mml:mi><mml:mo>˙</mml:mo><mml:mi>E</mml:mi></mml:mrow></mml:math>/Vco₂ slope, defined with a focus on high sensitivity and specificity. For each measure, patients were categorized into 3 groups based on these thresholds, yielding a proposed 9-field matrix for risk assessment. The frequency of complications between groups was compared using the χ² test. <h3>Results</h3> Overall, 29 patients (14%) suffered an MPC and 3 died. The frequency of complications differed between groups based on the 9-field matrix in patients who underwent lobectomy or pulmectomy (<i>P</i> < .001). No patient with both favorable percent predicted Vo₂peak and <mml:math><mml:mrow><mml:mi>V</mml:mi><mml:mo>˙</mml:mo><mml:mi>E</mml:mi></mml:mrow></mml:math>/Vco₂ slope values experienced MPC or death, whereas worsening values in both percent predicted Vo₂peak and <mml:math><mml:mrow><mml:mi>V</mml:mi><mml:mo>˙</mml:mo><mml:mi>E</mml:mi></mml:mrow></mml:math>/Vco₂ slope were associated with an increasing frequency of adverse outcomes. <h3>Interpretation</h3> The proposed 9-field matrix for risk assessment was able to demonstrate a synergistic effect between <mml:math><mml:mrow><mml:mi>V</mml:mi><mml:mo>˙</mml:mo><mml:mi>E</mml:mi></mml:mrow></mml:math>/Vco₂ slope and percent predicted Vo₂peak for identifying patients who suffered major pulmonary complications or death within 30 days of cancer lobectomy or pulmectomy. These results further improve and help nuance risk assessment in these patients.

ASO Visual Abstract: Predictive Value of Preoperative Cardiopulmonary Exercise Testing for Complications and Mortality After Esophagectomy: A Meta-analysis.

Preoperative cardiopulmonary exercise testing: physiological basis and investigation

Cardiopulmonary exercise testing (CPET) parameters, such as ventilatory equivalent for carbon dioxide (V̇E/V̇CO2), peak oxygen consumption (V̇O2peak), and anaerobic threshold (AT), have been proposed as potential predictors of postoperative complications. Yet, few systematic analyses have examined the association between CPET variables and major complications after esophagectomy, as defined by the Clavien-Dindo classification. Associations with cardiopulmonary complications and mortality also require updating on the basis of trial sequential analysis (TSA). Systematic searches were conducted to identify relevant studies reporting preoperative CPET values and major complications, cardiopulmonary complications, and 1-year mortality. Standardized mean differences (SMD, random-effects model) were calculated and TSA was conducted to evaluate the robustness of evidence in the previous and current meta-analyses. A total of 12 studies met inclusion criteria. V̇O2peak was correlated with major complications (SMD = - 0.42; 95% CI - 0.70 to - 0.14, p = 0.0032) and cardiopulmonary complications (SMD = - 0.39; 95% CI - 0.65 to - 0.13, p = 0.0032). AT showed similar but weaker associations with both outcomes (SMD = - 0.33 and - 0.22; 95% CI - 0.63 to - 0.03 and CI - 0.40 to - 0.04, p = 0.033 and 0.018, respectively). V̇E/V̇CO2 demonstrated no meaningful relationship with major complications. In addition, the present study found neither V̇O2peak nor AT was associated with 1-year mortality after esophagectomy. V̇O2peak and AT were inversely associated with morbidity after esophagectomy, while V̇E/V̇CO2 offered limited prognostic value and none predict 1-year survival. V̇O2peak is a key predictor of major and cardiopulmonary complications after esophagectomy and warrants further investigation, either alone or as part of a composite model.

Social determinants of health can influence surgical outcomes, with greater socio-economic deprivation linked to lower survival following elective surgery [1] and emergency laparotomy [2]. Understanding the mechanisms underlying this inequality is a prerequisite for the design of targeted healthcare strategies to reduce its impact. Whether these differences stem from pre-existing conditions, in-hospital factors or events following hospital discharge remains uncertain. Cardiopulmonary exercise testing (CPET) provides an objective measure of pre-operative functional capacity, and variables are associated with postoperative complications and mortality [3]. While results vary by age, sex and comorbidity [4], their relationship with socio-economic status remains poorly characterised [5]. We examined the potential association between area-level deprivation, measured using the Welsh Index of Multiple Deprivation and CPET performance, in the largest peri-operative cohort to date in Wales. Ethical approval was granted by the University of South Wales and Cardiff and Vale University Health Board. All adults (aged ≥ 16 y) undergoing pre-operative CPET at the University Hospital of Wales between 2008 and 2022 were included. Patients were not studied if testing was terminated for non-physiological reasons or if they resided outside Wales. For multiple tests, only the most recent was used. The principal exposure was socio-economic status, comprising income; employment; health; education; access to services; housing; community safety; and physical environment [6]. Quintiles were derived nationally, with Q1 representing the most, and Q5 the least, deprived areas. Patient, clinical and biochemical covariates were recorded. Exercise testing was performed using an electromagnetically braked cycle ergometer (Lode, Groningen, The Netherlands) and breath-by-breath analysis with a Medgraphics Ultima metabolic cart (MedGraphics™, Gloucester, UK), as described previously [7]. Primary outcomes were oxygen uptake at anaerobic threshold (V̇O2-AT) and peak exercise (V̇O2 peak). Continuous variables were compared using the Kruskal–Wallis rank sum test and categorical variables using the χ2 test, where appropriate. Multivariable linear regression was used to model associations between Welsh Index of Multiple Deprivation quintile and oxygen uptake at V̇O2 peak and V̇O2-AT, adjusting for relevant covariates. A total of 3479 patients met inclusion criteria (Table 1). Patients in Q1 were younger, with higher BMI, comorbidity burden, smoking prevalence and reduced lung function compared with Q5 (p < 0.001). The median (IQR [range]) V̇O2-AT was lowest in Q1 at 10.6 (9.1–12.3 [5.1–22.9]) ml.kg-1.min-1 vs. 11.0 (9.4–12.5 [5.2–26.0]) ml.kg-1.min-1 in Q5 (p = 0.015). Patients in Q1 reached V̇O2-AT at lower metabolic equivalents (METs) than those in Q5. The median (IQR [range]) V̇O2 peak was lowest in Q1 at 15.0 (12.0–18.4 [5.9–32.2]) ml.kg-1.min-1 and greatest in Q5 at 16.5 (13.2–19.8 [5.2–38.6]) ml.kg-1.min-1 (p < 0.001). Patients in Q1 reached V̇O2 peak earlier than those in Q5 (541 vs. 594 s, p < 0.001), and at lower heart rate (125 beats.min-1 vs. 130 beats.min-1, p < 0.001), exercise workload (86 W vs. 92 W, p < 0.001), and METs (4.3 vs. 4.7, p < 0.001). There was a significant positive association between deprivation quintile and V̇O2 peak (β = 0.35 ml.kg-1.min-1, 95%CI 0.24–0.45, p < 0.001). This remained significant following adjustment for baseline characteristics (age, sex, BMI, smoking status and surgical specialty), clinical variables (comorbidities, ischaemic heart disease, chronic obstructive pulmonary disease, peripheral vascular disease and anaemia); baseline spirometry; medications (use of beta blockers, lipid-lowering drugs); and for these combined (adjusted β = 0.21 ml.kg-1.min-1, 95%CI 0.13–0.29, p < 0.001). Baseline cardiopulmonary exercise testing measurements at rest showed no significant differences across deprivation quintiles, suggesting disparities are related to a dynamic response to exercise (Fig. 1). In this large peri-operative cohort in Wales, socio-economic deprivation was associated independently with reduced exercise capacity. These findings support previous work [8] and suggest that inequality exists even before hospitalisation, highlighting opportunities for targeted intervention. Tailored peri-operative strategies, including prehabilitation and comorbidity optimisation, may help mitigate these disparities. Future integration with surgical outcome data will clarify their role in shaping postoperative risk. No competing interests declared.

Shifting Paradigms: Exercise Testing as a Metric of Long-Term Success in Surgery for Ebstein Anomaly.

The widespread implementation of a preoperative assessment of aerobic capacity requires a practical field test. This study investigated the validity of the modified steep ramp test (SRT) for evaluating preoperative aerobic capacity and to evaluate its usefulness for preoperative risk assessment in patients planned for pancreatic surgery. Patients scheduled for pancreatic surgery who preoperatively performed cardiopulmonary exercise testing (CPET) and the modified SRT within 14days were included. To assess its criterion validity, the correlation between the achieved work rate at peak exercise (WRpeak) at the modified SRT and oxygen uptake (VO2) at peak exercise (VO2peak) during CPET was determined. To evaluate the ability of the modified SRT to correctly classify patients as fit or unfit, receiver operating characteristic (ROC) analyses were performed based on the CPET VO2peak cutoff 18.0ml.kg-1.min-1 and VO2 at the ventilatory anaerobic threshold (VAT) cutoff 11.0ml.kg-1.min-1. Forty-eight patients (21 females) aged 68.7±7.6years were included. Modified SRT WRpeak (W/kg) demonstrated a very strong correlation with CPET VO2peak (ρ=0.865, r=0.926). The modified SRT WRpeak cutoff to most accurately classify patients as fit or unfit was 2.095W/kg for the CPET VO2peak cutoff (area under the curve (AUC) of 0.948) and the CPET VO2 at the VAT cutoff (AUC of 0.814). The modified SRT is a valid short-term practical exercise test to preoperatively assess aerobic capacity in patients undergoing pancreatic surgery. A modified SRT performance below 2.1W/kg seems clinically most suitable to select candidates for further preoperative CPET evaluation and/or prehabilitation, given its positive and negative predictive value.

In various surgical cancer populations, a clear association has been reported between low preoperative aerobic fitness and poor postoperative outcomes. Yet, in pancreatic surgery, postoperative complications are mainly linked to pancreatic texture and duct diameter, and the role of aerobic fitness remains unclear. Patients referred for pancreatoduodenectomy at the University Medical Center Groningen were screened for low aerobic fitness using a questionnaire and referred for cardiopulmonary exercise testing (CPET) for aerobic fitness assessment accordingly. Based on CPET results, patients were classified as unfit when they had an oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 ml/kg/min and/or a VO2 at peak exercise ≤18 ml/kg/min. All patients received an advice to be physically active preoperatively and postoperative outcomes were compared to fit patients. Of 175 screened patients, 120 (68.6 %) were considered at risk for low aerobic fitness and underwent preoperative CPET. After excluding patients who participated in a supervised prehabilitation program, 106 CPET reports were used in the analysis. Forty-four (41.5 %) patients were classified as unfit. Postoperatively, unfit patients had a higher rate of gastroparesis grade ≥ B complications (40.9 % versus 22.6 % in fit patients, p = 0.043), and a prolonged length of stay (13 days versus 11 days in fit patients, p = 0.014). Low preoperative aerobic fitness is prevalent in patients undergoing pancreatoduodenectomy and a predictor of impaired postoperative outcomes. Aerobic fitness should therefore be included in the preoperative work-up and optimized accordingly in unfit patients scheduled to undergo pancreatoduodenectomy.

Peak oxygen uptake (VO2 peak) measured during cardiopulmonary exercise testing (CPET) is commonly used to objectively assess fitness and inform risk stratification. Preoperative CPET is not always universally available. Seismofit® offers a noninvasive, non-exercise alternative for estimating VO2 peak, though it has not been validated in patients awaiting major abdominal cancer surgery. Prospective single-centre blinded observational study in patients with hepato-pancreato-biliary, colorectal, or gastro-oesophageal cancer undergoing preoperative assessment. Patients underwent Seismofit® assessment before routine CPET. Primary outcome was the relationship between Seismofit®-estimated VO2 peak and CPET-measured VO2 peak. Secondary outcomes explored the relationship between Seismofit® and CPET for (i) bias and agreement limits; (ii) surgical subgroup; (iii) commonly reported CPET variables; (iv) patient acceptance. Thirty-three participants (median [interquartile range] age: 67 yr [58-75 yr]; 20 [61%] males) completed both CPET and Seismofit®. No linear association was found between Seismofit®-estimated VO2 peak and CPET-measured VO2 peak: Pearson r=0.111 (95% confidence interval-0.242 to 0.437), R 2=0.012, P=0.539. Compared with CPET, Seismofit® demonstrated a large bias (standard deviation) 12.8 (8.8); 95% limits of agreement (-4.5 to 30.0). No association existed between Seismofit®-estimated VO2 peak and CPET-measured VO2 peak in the hepato-pancreato-biliary or gastro-oesophageal subgroup or between Seismofit®-estimated VO2 peak and commonly reported CPET variables. There was no evidence of linear association between Seismofit®-estimated VO2 peak and objectively measured VO2 peak by CPET in patients undergoing assessment for major abdominal cancer surgery. This finding was consistent across all subgroup and exploratory analyses. Seismofit® tended to overestimate VO2 peak with a high degree of bias. NCT05831488.

AimsDescribe differences in changes in cardiopulmonary exercise testing after surgery for severe primary mitral regurgitation between class I and class II indications for surgery. Methods Prospective observational study of patients who underwent transthoracic echocardiogram and cardiopulmonary exercise testing pre-operatively and six months after surgery. Results Forty three of the fifty patients recruited between February 2017 and October 2018 were included in per protocol analysis. Seven patients were excluded-two patients did not meet inclusion criteria after further investigation, two patients were unable to perform pre-operative cardiopulmonary exercise testing, two patients had post-operative mortality, one patient declined post-operative cardiopulmonary exercise testing. Median age was 64 years and 15 patients (34.9%) were female. Thirty five patients had impaired post-operative functional capacity defined as post-operative left ventricular ejection fraction on echocardiogram <50% and/or post-operative percentage predicted peak VO2 ≤ 84%). In patients with class I indication for surgery (n = 30), there was no significant change post-operatively in ppVO2 (81 (69-88) % vs. 79 (60-87) %, p = 0.09). In patients with class II indication for surgery (n = 13), there was a significant fall post-operatively in ppVO2 (82 (79-92) % vs. (74 (68-86) %, p < 0.01). In the univariate analysis, pre-operative ppVO2 ≤ 84% (p < 0.01) was a predictor for impaired post-operative functional capacity. Conclusions Patients with class I indication have persistently abnormal exercise performance six months after surgery. Patients with class II indication for surgery have worse exercise performance parameters six months after surgery. Pre-operative ppVO2 ≤84% is an independent predictor of impaired post-operative functional capacity at six months.

Abstract RATIONALE: Guidelines from the American College of Chest Physicians (2013) and the European Respiratory Society/European Society of Thoracic Surgeons (2009) recommend using VO2peak from cardiopulmonary exercise testing (CPET) for risk stratification of postoperative pulmonary complications (PPCs). However, other CPET parameters and specific aspects of lung resection procedures remain unexplored, yet they may significantly influence surgical outcomes. METHODS: This study included 94 patients who underwent preoperative CPET before lung resection surgery at Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam, from January 2021 to August 2024. Eligibility required patients over 18 years old, excluding those who declined or ultimately did not undergo lung resection. Surgery indications included atelectasis due to post-tuberculosis bronchial stenosis (60%), lung tumors/cancer (28%), and other conditions like lung aspergilloma, bronchiectasis, lung abscess, and cysts. Data collection included spirometry, DLCO, CPET (conducted using a ramp protocol on a cycle ergometer), PaCO2, albumin, intraoperative details, and PPCs. RESULTS: Of the 94 patients, the male-to-female ratio was approximately 1:2.5. The mean VO2peak was 21.4 mL/kg/min, reaching 67% predicted. Ventilatory threshold 1 (VT1) was identified in 89 cases, averaging 14.7 mL/kg/min. PPCs occurred in 30 out of 94 cases (32%). Analysis revealed that VO2peak was weakly inversely associated with PPCs (r = -0.240; p = 0.020). Heart rate recovery showed a moderate inverse correlation with hospital stay duration (r = -0.321; p = 0.002). VE/VCO2 at VT1 (r = 0.374; p &amp;lt; 0.001) and surgical duration (r = 0.326; p = 0.001) were moderately positively correlated with hospital stay duration. Bronchoplastic surgery showed a moderate positive correlation with PPCs (r = 0.477; p &amp;lt; 0.001), a moderate inverse correlation with postoperative oxygen duration (r = -0.309; p = 0.002), and ICU stay duration (r = -0.482; p &amp;lt; 0.001). KCO (HGB) Z-score showed a moderate positive correlation with PPCs (r = 0.401; p = 0.010) and a moderate inverse correlation with postoperative ICU stay (r = -0.365; p = 0.021). Logistic regression incorporating VO2peak, FEV1, KCO (HGB), and bronchoplastic surgery yielded 90% accuracy in predicting PPCs, with an ROC-AUC of 0.943, sensitivity of 90%, specificity of 90%, PPV of 75%, and NPV of 96%. CONCLUSION: The study identifies a broader range of CPET indices, bronchoplastic surgery, and KCO as significant predictors of outcomes following lung resection. These findings suggest that considering multiple CPET parameters in addition to VO2peak may enhance postoperative respiratory outcome predictions.