You have accessJournal of UrologyUrothelial Cancer: Medical & Surgical Therapy1 Apr 2013515 IMPAIRED CARDIOPULMONARY RESERVE IN AN ELDERLY POPULATION IS RELATED TO POSTOPERATIVE MORBIDITY AND HOSPITAL LENGTH OF STAY AFTER RADICAL CYSTECTOMY Nikhil Vasdev, James Prentis, Rachel French, Georgina Dines, Chris Snowden, and Andrew Thorpe Nikhil VasdevNikhil Vasdev Newcastle upon Tyne, United Kingdom More articles by this author , James PrentisJames Prentis Newcastle upon Tyne, United Kingdom More articles by this author , Rachel FrenchRachel French Newcastle upon Tyne, United Kingdom More articles by this author , Georgina DinesGeorgina Dines Newcastle upon Tyne, United Kingdom More articles by this author , Chris SnowdenChris Snowden Newcastle upon Tyne, United Kingdom More articles by this author , and Andrew ThorpeAndrew Thorpe Newcastle upon Tyne, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1909AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the relationship of preoperatively measured cardiopulmonary function, to the development of postoperative complications and hospital length of stay in a cohort of patients undergoing radical cystectomy (RC). METHODS Eighty two consecutive patients were scheduled to undergo planned a RC and all patients underwent pre-operative cardiopulmonary exercise testing (CPET) to a standardised protocol. The results of the CPET were blinded from the clinicians involved in the care of the patients. Patients were prospectively monitored for the primary outcome of postoperative complications, as defined by a validated classification (Clavien-Dindo). Secondary outcomes included hospital length of stay and use of critical care resource. RESULTS Eight patients (8/82 = 9.7%) did not undergo surgery and a further 5 patients did not exercise sufficiently to allow for the determination of the anaerobic threshold. There was a significant difference in hospital length of stay between those patients who had a major perioperative complication (Clavien score 3+) to those that did not (15.5 vs 30 p<0.0001 HR 3.6 95% CI 2.1-6.3). The anaerobic threshold remained as the only significant independent predictor variable for the presence or absence of major postoperative complications (coeff −0.30 Std error 0.14 p=0.03 OR 0.74 95% CI 0.57-0.97). When the optimal value of At-12ml/min/kg, derived from the ROC curve was used as a cut value, analysis revealed a significant difference between cardiorespiratory fitness related risk groups with respect to length of hospital stay (Median Hospital LOS: Unfit 22 vs fit 16 days HR 0.47 95% CI 0.28 - 0.80 p=0.006). CONCLUSIONS Impaired preoperative cardiopulmonary reserve was related to major morbidity, prolonged hospital stay and increased use of critical care resource after radical cystectomy. This has important health and economic implications for risk assessment, rationalization of postoperative resource and the potential for therapeutic preoperative intervention with exercise therapy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e211 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhil Vasdev Newcastle upon Tyne, United Kingdom More articles by this author James Prentis Newcastle upon Tyne, United Kingdom More articles by this author Rachel French Newcastle upon Tyne, United Kingdom More articles by this author Georgina Dines Newcastle upon Tyne, United Kingdom More articles by this author Chris Snowden Newcastle upon Tyne, United Kingdom More articles by this author Andrew Thorpe Newcastle upon Tyne, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...