Measurement of Exercise Tolerance before Surgery (METS) study: A protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery

Duminda N Wijeysundera, Rupert M Pearse, Mark A Shulman, Tom E F Abbott, Elizabeth Torres, Bernard L Croal, John T Granton, Kevin E Thorpe, Michael P W Grocott, Catherine Farrington, Paul S Myles, Brian H Cuthbertson, on behalf of the METS study investigators

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction: Preoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors' subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration of N-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia. Methods and analysis: The Measurement of Exercise Tolerance before Surgery (METS) Study is a multicentre prospective cohort study of patients undergoing major elective non-cardiac surgery at 25 participating study sites in Australia, Canada, New Zealand and the UK. We aim to recruit 1723 participants. Prior to surgery, participants undergo symptom-limited cardiopulmonary exercise testing on a cycle ergometer, complete the Duke Activity Status Index questionnaire, undergo blood sampling to measure serum NT pro-BNP concentration and have their functional capacity subjectively assessed by their responsible doctors. Participants are followed for 1 year after surgery to assess vital status, postoperative complications and general health utilities. The primary outcome is all-cause death or non-fatal myocardial infarction within 30 days after surgery, and the secondary outcome is all-cause death within 1 year after surgery. Both receiver-operating-characteristic curve methods and risk reclassification table methods will be used to compare the prognostic accuracy of preoperative subjective assessment, peak oxygen consumption during cardiopulmonary exercise testing, Duke Activity Status Index scores and serum NT pro- BNP concentration. Ethics and dissemination: The METS Study has received research ethics board approval at all sites. Participant recruitment began in March 2013, and 1- year follow-up is expected to finish in 2016. Publication of the results of the METS Study is anticipated to occur in 2017.

Original languageEnglish
Article numbere010359
Number of pages10
JournalBMJ Open
Volume6
Issue number3
DOIs
Publication statusPublished - 2016

Cite this

Wijeysundera, Duminda N ; Pearse, Rupert M ; Shulman, Mark A ; Abbott, Tom E F ; Torres, Elizabeth ; Croal, Bernard L ; Granton, John T ; Thorpe, Kevin E ; Grocott, Michael P W ; Farrington, Catherine ; Myles, Paul S ; Cuthbertson, Brian H ; on behalf of the METS study investigators. / Measurement of Exercise Tolerance before Surgery (METS) study : A protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery. In: BMJ Open. 2016 ; Vol. 6, No. 3.
@article{c01424ff6035412cb8da6c50dc288c6f,
title = "Measurement of Exercise Tolerance before Surgery (METS) study: A protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery",
abstract = "Introduction: Preoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors' subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration of N-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia. Methods and analysis: The Measurement of Exercise Tolerance before Surgery (METS) Study is a multicentre prospective cohort study of patients undergoing major elective non-cardiac surgery at 25 participating study sites in Australia, Canada, New Zealand and the UK. We aim to recruit 1723 participants. Prior to surgery, participants undergo symptom-limited cardiopulmonary exercise testing on a cycle ergometer, complete the Duke Activity Status Index questionnaire, undergo blood sampling to measure serum NT pro-BNP concentration and have their functional capacity subjectively assessed by their responsible doctors. Participants are followed for 1 year after surgery to assess vital status, postoperative complications and general health utilities. The primary outcome is all-cause death or non-fatal myocardial infarction within 30 days after surgery, and the secondary outcome is all-cause death within 1 year after surgery. Both receiver-operating-characteristic curve methods and risk reclassification table methods will be used to compare the prognostic accuracy of preoperative subjective assessment, peak oxygen consumption during cardiopulmonary exercise testing, Duke Activity Status Index scores and serum NT pro- BNP concentration. Ethics and dissemination: The METS Study has received research ethics board approval at all sites. Participant recruitment began in March 2013, and 1- year follow-up is expected to finish in 2016. Publication of the results of the METS Study is anticipated to occur in 2017.",
author = "Wijeysundera, {Duminda N} and Pearse, {Rupert M} and Shulman, {Mark A} and Abbott, {Tom E F} and Elizabeth Torres and Croal, {Bernard L} and Granton, {John T} and Thorpe, {Kevin E} and Grocott, {Michael P W} and Catherine Farrington and Myles, {Paul S} and Cuthbertson, {Brian H} and {on behalf of the METS study investigators} and B. Thompson and M. Ellis and E. Wright and A. Hall and K. Leslie and L. Day and L. Lee and D. Campbell and T. Short and C. Wong and M. Lum and D. Martin and J. McNeil and M. Edwards and K. Salmon",
year = "2016",
doi = "10.1136/bmjopen-2015-010359",
language = "English",
volume = "6",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "3",

}

Wijeysundera, DN, Pearse, RM, Shulman, MA, Abbott, TEF, Torres, E, Croal, BL, Granton, JT, Thorpe, KE, Grocott, MPW, Farrington, C, Myles, PS, Cuthbertson, BH & on behalf of the METS study investigators 2016, 'Measurement of Exercise Tolerance before Surgery (METS) study: A protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery' BMJ Open, vol. 6, no. 3, e010359. https://doi.org/10.1136/bmjopen-2015-010359

Measurement of Exercise Tolerance before Surgery (METS) study : A protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery. / Wijeysundera, Duminda N; Pearse, Rupert M; Shulman, Mark A; Abbott, Tom E F; Torres, Elizabeth; Croal, Bernard L; Granton, John T; Thorpe, Kevin E; Grocott, Michael P W; Farrington, Catherine; Myles, Paul S; Cuthbertson, Brian H; on behalf of the METS study investigators.

In: BMJ Open, Vol. 6, No. 3, e010359, 2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Measurement of Exercise Tolerance before Surgery (METS) study

T2 - A protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery

AU - Wijeysundera, Duminda N

AU - Pearse, Rupert M

AU - Shulman, Mark A

AU - Abbott, Tom E F

AU - Torres, Elizabeth

AU - Croal, Bernard L

AU - Granton, John T

AU - Thorpe, Kevin E

AU - Grocott, Michael P W

AU - Farrington, Catherine

AU - Myles, Paul S

AU - Cuthbertson, Brian H

AU - on behalf of the METS study investigators

AU - Thompson, B.

AU - Ellis, M.

AU - Wright, E.

AU - Hall, A.

AU - Leslie, K.

AU - Day, L.

AU - Lee, L.

AU - Campbell, D.

AU - Short, T.

AU - Wong, C.

AU - Lum, M.

AU - Martin, D.

AU - McNeil, J.

AU - Edwards, M.

AU - Salmon, K.

PY - 2016

Y1 - 2016

N2 - Introduction: Preoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors' subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration of N-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia. Methods and analysis: The Measurement of Exercise Tolerance before Surgery (METS) Study is a multicentre prospective cohort study of patients undergoing major elective non-cardiac surgery at 25 participating study sites in Australia, Canada, New Zealand and the UK. We aim to recruit 1723 participants. Prior to surgery, participants undergo symptom-limited cardiopulmonary exercise testing on a cycle ergometer, complete the Duke Activity Status Index questionnaire, undergo blood sampling to measure serum NT pro-BNP concentration and have their functional capacity subjectively assessed by their responsible doctors. Participants are followed for 1 year after surgery to assess vital status, postoperative complications and general health utilities. The primary outcome is all-cause death or non-fatal myocardial infarction within 30 days after surgery, and the secondary outcome is all-cause death within 1 year after surgery. Both receiver-operating-characteristic curve methods and risk reclassification table methods will be used to compare the prognostic accuracy of preoperative subjective assessment, peak oxygen consumption during cardiopulmonary exercise testing, Duke Activity Status Index scores and serum NT pro- BNP concentration. Ethics and dissemination: The METS Study has received research ethics board approval at all sites. Participant recruitment began in March 2013, and 1- year follow-up is expected to finish in 2016. Publication of the results of the METS Study is anticipated to occur in 2017.

AB - Introduction: Preoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors' subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration of N-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia. Methods and analysis: The Measurement of Exercise Tolerance before Surgery (METS) Study is a multicentre prospective cohort study of patients undergoing major elective non-cardiac surgery at 25 participating study sites in Australia, Canada, New Zealand and the UK. We aim to recruit 1723 participants. Prior to surgery, participants undergo symptom-limited cardiopulmonary exercise testing on a cycle ergometer, complete the Duke Activity Status Index questionnaire, undergo blood sampling to measure serum NT pro-BNP concentration and have their functional capacity subjectively assessed by their responsible doctors. Participants are followed for 1 year after surgery to assess vital status, postoperative complications and general health utilities. The primary outcome is all-cause death or non-fatal myocardial infarction within 30 days after surgery, and the secondary outcome is all-cause death within 1 year after surgery. Both receiver-operating-characteristic curve methods and risk reclassification table methods will be used to compare the prognostic accuracy of preoperative subjective assessment, peak oxygen consumption during cardiopulmonary exercise testing, Duke Activity Status Index scores and serum NT pro- BNP concentration. Ethics and dissemination: The METS Study has received research ethics board approval at all sites. Participant recruitment began in March 2013, and 1- year follow-up is expected to finish in 2016. Publication of the results of the METS Study is anticipated to occur in 2017.

UR - http://www.scopus.com/inward/record.url?scp=84962535215&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2015-010359

DO - 10.1136/bmjopen-2015-010359

M3 - Article

VL - 6

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 3

M1 - e010359

ER -