Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repair
Abstract Background Reliable prediction of the preoperative risk is of crucial importance for patients undergoing aortic repair. In this retrospective cohort study, we evaluated the metabolic equivalent of task (MET) in the preoperative risk assessment with clinical outcome in a cohort of consecutiv...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-021-01143-0 |
| _version_ | 1819158200821219328 |
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| author | Alicja Zientara Igor Schwegler Omer Dzemali Hans Bruijnen Alain Bernheim Florian Dick Nicolas Attigah |
| author_facet | Alicja Zientara Igor Schwegler Omer Dzemali Hans Bruijnen Alain Bernheim Florian Dick Nicolas Attigah |
| author_sort | Alicja Zientara |
| collection | DOAJ |
| description | Abstract Background Reliable prediction of the preoperative risk is of crucial importance for patients undergoing aortic repair. In this retrospective cohort study, we evaluated the metabolic equivalent of task (MET) in the preoperative risk assessment with clinical outcome in a cohort of consecutive patients. Methods Retrospective analysis of prospectively collected data in a single center unit of 296 patients undergoing open or endovascular aortic repair from 2009 to 2016. The patients were divided into four anatomic main groups (infrarenal (endo: n = 94; open: n = 88), juxta- and para-renal (open n = 84), thoraco-abdominal (open n = 13) and thoracic (endo: n = 11; open: n = 6). Out of these, 276 patients had a preoperative statement of their functional capacity in metabolic units and were evaluated concerning their postoperative outcome including survival, in-hospital mortality, postoperative complications, myocardial infarction and stroke, and the need of later cardiovascular interventions. Results The median follow-up of the cohort was 10.8 months. Patients with < 4MET had a higher incidence of diabetes mellitus (p = 0.0002), peripheral arterial disease (p < 0.0001), history of smoking (p = 0.003), obesity (p = 0.03) and chronic obstructive pulmonary disease (p = 0.05). Overall in-hospital mortality was 4.4% (13 patients). There was no significant difference in the survival between patients with a functional capacity of more than 4 MET (220 patients, mean survival: 74.5 months) and patients with less than 4 MET (56 patients, mean survival: 65.4 months) (p = 0.64). The mean survival of the infrarenal cohort (n = 169) was 74.3 months with no significant differences between both MET groups (> 4 MET: 131 patients, mean survival 75.5 months; < 4 MET: 38 patients, mean survival 63.6 months. p = 0.35). The subgroup after open surgical technique with less than 4 MET had the lowest mean survival of 38.8 months. In 46 patients with > 4MET (20.9%) perioperative complications occurred compared to the group with < 4MET with 18 patients (32.1%) (p = 0.075). There were no significant differences in both groups in the late cardiovascular interventions (p = 0.91) and major events including stroke and myocardial infarction (p = 0.4) monitored during the follow up period. The risk to miss a potential need for cardiac optimization in patients > 4MET was 7%. Conclusion The functional preoperative evaluation by MET in patients undergoing aortic surgery is a useful surrogate marker of perioperative performance but cannot be seen as a substitute for preoperative cardiopulmonary testing in selected individuals. Trial registration clinicaltrials.gov, registration number NCT03617601 (retrospectively registered). |
| first_indexed | 2024-12-22T16:20:53Z |
| format | Article |
| id | doaj.art-ba4a19148c4a478bbb7971acaae90814 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-22T16:20:53Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
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| series | BMC Surgery |
| spelling | doaj.art-ba4a19148c4a478bbb7971acaae908142022-12-21T18:20:15ZengBMCBMC Surgery1471-24822021-03-012111910.1186/s12893-021-01143-0Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repairAlicja Zientara0Igor Schwegler1Omer Dzemali2Hans Bruijnen3Alain Bernheim4Florian Dick5Nicolas Attigah6Department of Cardiac Surgery, Royal Brompton and Harefield HospitalDepartment of Vascular Surgery, Triemli HospitalDepartment of Cardiac Surgery, Triemli HospitalDepartment of Vascular and Thoracic Surgery, Augsburg HospitalDepartment of Cardiology, Triemli HospitalDepartment of Vascular Surgery, Cantonal HospitalDepartment of Vascular Surgery, Triemli HospitalAbstract Background Reliable prediction of the preoperative risk is of crucial importance for patients undergoing aortic repair. In this retrospective cohort study, we evaluated the metabolic equivalent of task (MET) in the preoperative risk assessment with clinical outcome in a cohort of consecutive patients. Methods Retrospective analysis of prospectively collected data in a single center unit of 296 patients undergoing open or endovascular aortic repair from 2009 to 2016. The patients were divided into four anatomic main groups (infrarenal (endo: n = 94; open: n = 88), juxta- and para-renal (open n = 84), thoraco-abdominal (open n = 13) and thoracic (endo: n = 11; open: n = 6). Out of these, 276 patients had a preoperative statement of their functional capacity in metabolic units and were evaluated concerning their postoperative outcome including survival, in-hospital mortality, postoperative complications, myocardial infarction and stroke, and the need of later cardiovascular interventions. Results The median follow-up of the cohort was 10.8 months. Patients with < 4MET had a higher incidence of diabetes mellitus (p = 0.0002), peripheral arterial disease (p < 0.0001), history of smoking (p = 0.003), obesity (p = 0.03) and chronic obstructive pulmonary disease (p = 0.05). Overall in-hospital mortality was 4.4% (13 patients). There was no significant difference in the survival between patients with a functional capacity of more than 4 MET (220 patients, mean survival: 74.5 months) and patients with less than 4 MET (56 patients, mean survival: 65.4 months) (p = 0.64). The mean survival of the infrarenal cohort (n = 169) was 74.3 months with no significant differences between both MET groups (> 4 MET: 131 patients, mean survival 75.5 months; < 4 MET: 38 patients, mean survival 63.6 months. p = 0.35). The subgroup after open surgical technique with less than 4 MET had the lowest mean survival of 38.8 months. In 46 patients with > 4MET (20.9%) perioperative complications occurred compared to the group with < 4MET with 18 patients (32.1%) (p = 0.075). There were no significant differences in both groups in the late cardiovascular interventions (p = 0.91) and major events including stroke and myocardial infarction (p = 0.4) monitored during the follow up period. The risk to miss a potential need for cardiac optimization in patients > 4MET was 7%. Conclusion The functional preoperative evaluation by MET in patients undergoing aortic surgery is a useful surrogate marker of perioperative performance but cannot be seen as a substitute for preoperative cardiopulmonary testing in selected individuals. Trial registration clinicaltrials.gov, registration number NCT03617601 (retrospectively registered).https://doi.org/10.1186/s12893-021-01143-0Metabolic equivalent of task (MET)Aortic repairPreoperative assessmentFunctional capacity |
| spellingShingle | Alicja Zientara Igor Schwegler Omer Dzemali Hans Bruijnen Alain Bernheim Florian Dick Nicolas Attigah Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repair BMC Surgery Metabolic equivalent of task (MET) Aortic repair Preoperative assessment Functional capacity |
| title | Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repair |
| title_full | Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repair |
| title_fullStr | Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repair |
| title_full_unstemmed | Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repair |
| title_short | Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repair |
| title_sort | evaluation of metabolic equivalents of task mets in the preoperative assessment in aortic repair |
| topic | Metabolic equivalent of task (MET) Aortic repair Preoperative assessment Functional capacity |
| url | https://doi.org/10.1186/s12893-021-01143-0 |
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