Abstract
BACKGROUND: Ventilation as a function of elimination of CO(2) during incremental exercise (VE/VCO(2) slope) has been shown to be a valuable predictor of complications and death after major non-cardiac surgery. VE/VCO(2) slope and partial pressure of end-tidal carbon dioxide (PetCO(2)) are both affected by ventilation/perfusion mismatch, but research on the utility of PetCO(2) for risk stratification in major abdominal surgery is limited. AIM: We aimed to determine the correlation between VE/VCO(2) slope and PetCO(2) measured during preoperative cardiopulmonary exercise testing (CPET) and its association with major cardiopulmonary complications (MCPCs) or death following oesophageal and other major abdominal cancer surgeries. METHOD: In a retrospective cohort of 116 patients undergoing preoperative CPET 2008-2023, VE/VCO(2) slope and PetCO(2) (kPa) were recorded. The main outcome was MCPC during hospitalisation or death ≤90 days of surgery. We determined threshold values for each measure, corresponding to 90% specificity, using receiver operating characteristics analysis. RESULTS: A strong negative correlation was found between PetCO(2) after a 5-minute warm-up and VE/VCO(2) slope (Pearson r = -.88). In oesophagus cancer, VE/VCO(2) slope >38 and PetCO(2) < 4.1 kPa (30.8 mmHg) were both significant thresholds for the main outcome. For other major abdominal surgery patients, threshold analyses were non-significant. The area under the curve to predict outcome was similar using VE/VCO(2) slope (0.70, 95% confidence interval 0.51-0.89) as compared to PetCO(2) (0.71, 0.53-0-90). CONCLUSION: Both preoperative VE/VCO(2) slope and PetCO(2) could identify subjects with a very high risk of complications following oesophageal resection, with similar prognostic utility. PetCO(2) can be measured with simpler equipment and could therefore be useful when CPET is not available.