Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery: a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study

J. Bartoszko, K. E. Thorpe, A. Laupacis, D. N. Wijeysundera, on behalf of the METS study investigators

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Preoperative anaemia is associated with elevated risks of postoperative complications. This association may be explained by confounding related to poor cardiopulmonary fitness. We conducted a pre-specified substudy of the Measurement of Exercise Tolerance before Surgery (METS) study to examine the associations of preoperative haemoglobin concentration with preoperative cardiopulmonary exercise testing performance (peak oxygen consumption, anaerobic threshold) and postoperative complications. Methods: The substudy included a nested cross-sectional analysis and nested cohort analysis. In the cross-sectional study (1279 participants), multivariate linear regression modelling was used to determine the adjusted association of haemoglobin concentration with peak oxygen consumption and anaerobic threshold. In the nested cohort study (1256 participants), multivariable logistic regression modelling was used to determine the adjusted association of haemoglobin concentration, peak oxygen consumption, and anaerobic threshold with the primary endpoint (composite outcome of death, cardiovascular complications, acute kidney injury, or surgical site infection) and secondary endpoint (moderate or severe complications). Results: Haemoglobin concentration explained 3.8% of the variation in peak oxygen consumption and anaerobic threshold (P<0.001). Although not associated with the primary endpoint, haemoglobin concentration was associated with moderate or severe complications after adjustment for peak oxygen consumption (odds ratio=0.86 per 10 g L−1 increase; 95% confidence interval, 0.77–0.96) or anaerobic threshold (odds ratio=0.86; 95% confidence interval, 0.77–0.97). Lower peak oxygen consumption was associated with moderate or severe complications without effect modification by haemoglobin concentration (P=0.12). Conclusion: Haemoglobin concentration explains a small proportion of variation in exercise capacity. Both anaemia and poor functional capacity are associated with postoperative complications and may therefore be modifiable targets for preoperative optimisation.

Original languageEnglish
Number of pages9
JournalBritish Journal of Anaesthesia
DOIs
Publication statusAccepted/In press - 9 Apr 2019
Externally publishedYes

Keywords

  • anaemia
  • cardiopulmonary exercise testing
  • exercise tolerance
  • perioperative period
  • postoperative complications

Cite this

@article{494b38b1f7e8430bac081d915e84bd16,
title = "Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery: a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study",
abstract = "Background: Preoperative anaemia is associated with elevated risks of postoperative complications. This association may be explained by confounding related to poor cardiopulmonary fitness. We conducted a pre-specified substudy of the Measurement of Exercise Tolerance before Surgery (METS) study to examine the associations of preoperative haemoglobin concentration with preoperative cardiopulmonary exercise testing performance (peak oxygen consumption, anaerobic threshold) and postoperative complications. Methods: The substudy included a nested cross-sectional analysis and nested cohort analysis. In the cross-sectional study (1279 participants), multivariate linear regression modelling was used to determine the adjusted association of haemoglobin concentration with peak oxygen consumption and anaerobic threshold. In the nested cohort study (1256 participants), multivariable logistic regression modelling was used to determine the adjusted association of haemoglobin concentration, peak oxygen consumption, and anaerobic threshold with the primary endpoint (composite outcome of death, cardiovascular complications, acute kidney injury, or surgical site infection) and secondary endpoint (moderate or severe complications). Results: Haemoglobin concentration explained 3.8{\%} of the variation in peak oxygen consumption and anaerobic threshold (P<0.001). Although not associated with the primary endpoint, haemoglobin concentration was associated with moderate or severe complications after adjustment for peak oxygen consumption (odds ratio=0.86 per 10 g L−1 increase; 95{\%} confidence interval, 0.77–0.96) or anaerobic threshold (odds ratio=0.86; 95{\%} confidence interval, 0.77–0.97). Lower peak oxygen consumption was associated with moderate or severe complications without effect modification by haemoglobin concentration (P=0.12). Conclusion: Haemoglobin concentration explains a small proportion of variation in exercise capacity. Both anaemia and poor functional capacity are associated with postoperative complications and may therefore be modifiable targets for preoperative optimisation.",
keywords = "anaemia, cardiopulmonary exercise testing, exercise tolerance, perioperative period, postoperative complications",
author = "J. Bartoszko and Thorpe, {K. E.} and A. Laupacis and Wijeysundera, {D. N.} and {on behalf of the METS study investigators}",
year = "2019",
month = "4",
day = "9",
doi = "10.1016/j.bja.2019.04.058",
language = "English",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",

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Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery : a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study. / Bartoszko, J.; Thorpe, K. E.; Laupacis, A.; Wijeysundera, D. N.; on behalf of the METS study investigators.

In: British Journal of Anaesthesia, 09.04.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery

T2 - a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study

AU - Bartoszko, J.

AU - Thorpe, K. E.

AU - Laupacis, A.

AU - Wijeysundera, D. N.

AU - on behalf of the METS study investigators

PY - 2019/4/9

Y1 - 2019/4/9

N2 - Background: Preoperative anaemia is associated with elevated risks of postoperative complications. This association may be explained by confounding related to poor cardiopulmonary fitness. We conducted a pre-specified substudy of the Measurement of Exercise Tolerance before Surgery (METS) study to examine the associations of preoperative haemoglobin concentration with preoperative cardiopulmonary exercise testing performance (peak oxygen consumption, anaerobic threshold) and postoperative complications. Methods: The substudy included a nested cross-sectional analysis and nested cohort analysis. In the cross-sectional study (1279 participants), multivariate linear regression modelling was used to determine the adjusted association of haemoglobin concentration with peak oxygen consumption and anaerobic threshold. In the nested cohort study (1256 participants), multivariable logistic regression modelling was used to determine the adjusted association of haemoglobin concentration, peak oxygen consumption, and anaerobic threshold with the primary endpoint (composite outcome of death, cardiovascular complications, acute kidney injury, or surgical site infection) and secondary endpoint (moderate or severe complications). Results: Haemoglobin concentration explained 3.8% of the variation in peak oxygen consumption and anaerobic threshold (P<0.001). Although not associated with the primary endpoint, haemoglobin concentration was associated with moderate or severe complications after adjustment for peak oxygen consumption (odds ratio=0.86 per 10 g L−1 increase; 95% confidence interval, 0.77–0.96) or anaerobic threshold (odds ratio=0.86; 95% confidence interval, 0.77–0.97). Lower peak oxygen consumption was associated with moderate or severe complications without effect modification by haemoglobin concentration (P=0.12). Conclusion: Haemoglobin concentration explains a small proportion of variation in exercise capacity. Both anaemia and poor functional capacity are associated with postoperative complications and may therefore be modifiable targets for preoperative optimisation.

AB - Background: Preoperative anaemia is associated with elevated risks of postoperative complications. This association may be explained by confounding related to poor cardiopulmonary fitness. We conducted a pre-specified substudy of the Measurement of Exercise Tolerance before Surgery (METS) study to examine the associations of preoperative haemoglobin concentration with preoperative cardiopulmonary exercise testing performance (peak oxygen consumption, anaerobic threshold) and postoperative complications. Methods: The substudy included a nested cross-sectional analysis and nested cohort analysis. In the cross-sectional study (1279 participants), multivariate linear regression modelling was used to determine the adjusted association of haemoglobin concentration with peak oxygen consumption and anaerobic threshold. In the nested cohort study (1256 participants), multivariable logistic regression modelling was used to determine the adjusted association of haemoglobin concentration, peak oxygen consumption, and anaerobic threshold with the primary endpoint (composite outcome of death, cardiovascular complications, acute kidney injury, or surgical site infection) and secondary endpoint (moderate or severe complications). Results: Haemoglobin concentration explained 3.8% of the variation in peak oxygen consumption and anaerobic threshold (P<0.001). Although not associated with the primary endpoint, haemoglobin concentration was associated with moderate or severe complications after adjustment for peak oxygen consumption (odds ratio=0.86 per 10 g L−1 increase; 95% confidence interval, 0.77–0.96) or anaerobic threshold (odds ratio=0.86; 95% confidence interval, 0.77–0.97). Lower peak oxygen consumption was associated with moderate or severe complications without effect modification by haemoglobin concentration (P=0.12). Conclusion: Haemoglobin concentration explains a small proportion of variation in exercise capacity. Both anaemia and poor functional capacity are associated with postoperative complications and may therefore be modifiable targets for preoperative optimisation.

KW - anaemia

KW - cardiopulmonary exercise testing

KW - exercise tolerance

KW - perioperative period

KW - postoperative complications

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JF - British Journal of Anaesthesia

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