Abstract Background Assessment of exercise capacity is an important component of risk assessment before major surgery. Cardiopulmonary exercise testing (CPET) provides comprehensive assessment but is resource-intensive, limiting widespread adoption. Measurement of a patient’s peak power output (PPO) using a simplified test on a cycle ergometer has the potential to identify patients likely to have abnormal CPET findings and to be at increased perioperative risk. The aim of this study was to investigate the potential for PPO to identify those with abnormal CPET and to determine whether PPO predicted the risk of adverse postoperative outcomes. Methods In a retrospective analysis of a single-centre cohort, the ability of PPO to predict a high-risk CPET result in patients undergoing major cancer surgery was analysed. The assessment was validated in patients undergoing major abdominal surgery from a UK national multicentre cohort. The association between PPO and adverse postoperative outcomes to traditional CPET-derived variables were compared. Results In 2262 patients from a single centre, PPO was an excellent discriminator of high-risk CPET, with an area under the receiver operating characteristic curve (AUROC) of 0.901 (95 per cent c.i. 0.888 to 0.913). In the national cohort of 2742 patients, there was excellent discrimination, with an AUROC of 0.856 (0.842 to 0.871). A PPO cut-off of 1.5 W/kg may be appropriate for use in screening, with a sensitivity of 90 per cent in both cohorts. PPO and traditional CPET-derived predictors demonstrated similar discrimination of major postoperative complications and death. The association between PPO and major postoperative complications persisted on multivariable analysis. Conclusion These results suggest a role for the PPO test in preoperative screening and risk stratification for major surgery. Prospective evaluation is recommended.

中文翻译：

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峰值功率输出测试：术前评估运动能力的新方法

摘要 背景运动能力评估是大手术前风险评估的重要组成部分。心肺运动测试 (CPET) 提供全面的评估，但资源密集型，限制了广泛采用。使用自行车测力计上的简化测试来测量患者的峰值功率输出 (PPO)，有可能识别出可能具有异常 CPET 结果以及围手术期风险增加的患者。本研究的目的是调查 PPO 识别 CPET 异常患者的潜力，并确定 PPO 是否可以预测不良术后结果的风险。 方法在单中心队列的回顾性分析中，分析了 PPO 预测接受重大癌症手术的患者高风险 CPET 结果的能力。该评估在英国国家多中心队列中接受腹部大手术的患者中得到了验证。将 PPO 和术后不良结果与传统 CPET 衍生变量之间的关联进行了比较。 结果在来自单个中心的 2262 名患者中，PPO 是高风险 CPET 的出色鉴别指标，受试者工作特征曲线下面积 (AUROC) 为 0.901（95% CI 0.888 至 0.913）。在由 2742 名患者组成的全国队列中，区分度极好，AUROC 为 0.856（0.842 至 0.871）。1.5 W/kg 的 PPO 截止值可能适合用于筛查，两个队列的敏感性均为 90%。PPO 和传统的 CPET 衍生预测因子表现出对主要术后并发症和死亡的相似区分。PPO 与主要术后并发症之间的关联在多变量分析中仍然存在。 结论这些结果表明 PPO 测试在大手术的术前筛查和风险分层中发挥作用。建议进行前瞻性评估。