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• W2897919049 abstract "Bowel cancer is the third most common cancer in the UK 1. Many of these patients will present for surgical treatment. The 2017 Annual Report of the National Bowel Cancer Audit describes data collected from over 30,000 patients diagnosed with bowel cancer between April 2015 and March 2016 in England and Wales 2. This national audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and funded by NHS England and Wales. The audit is carried out by the Clinical Effectiveness Unit of the Royal College of Surgeons of England in partnership with the Association of Coloproctology of Great Britain and Ireland and NHS Digital. Sixty-three percent of these patients had undergone a major surgical resection 2. Centres in the UK are increasingly using pre-operative cardiopulmonary exercise testing (CPET) to risk stratify patients before major surgery. Within the same period, the National Bowel Cancer Audit conducted an organisational survey to determine the availability of on-site services including CPET for the objective evaluation of cardiopulmonary fitness and peri-operative risk at each NHS site 3. Cardiopulmonary exercise testing-derived metrics have the potential to predict morbidity and mortality after major abdominal surgery 4. It may also allow individualised risk assessment; inform shared decision making; identify requirement for postoperative critical care; and assesses and identifiy scope for optimisation of comorbidities and prehabilitation 5. The latest survey of CPET in the UK identified increasing utilisation with over 30,000 tests performed annually 6. National Bowel Cancer Audit data are publicly available online under the Open Government Licence via NHS Digital. We analysed the two latest datasets 2, 3 to determine if there were any differences between the clinical outcomes of patients who underwent surgery in centres with and without CPET. We compared 90-day mortality between hospitals that provided CPET and those that did not. Statistical analysis was conducted using MedCalc Statistical Software version 16.4.3 (MedCalc Software bvba, Ostend, Belgium; 2016). Patients were pooled for sites with and without CPET facilities. Relative risk (RR) was calculated for patients treated at sites with and without CPET. In centres that had onsite CPET facilities, 10,694/17,986 (59%) patients had major surgery. This was associated with an 18% reduction (RR 0.82, 95%CI 0.70–0.96, p = 0.0157) in 90-day mortality in centres that had CPET. There was no significant difference in disease severity (patients with distant metastases at the time of surgery) between centres with and without CPET (RR 0.99, 95%CI 0.90–1.09, p = 0.7947) or in the volume of patients in each centre on a curative major resection treatment pathway (RR 1.01, 95%CI 0.98–1.05, p = 0.53). Although there were more patients recorded as ASA status 1 in centres with CPET (RR 1.1, 95%CI 1.02–1.20, P = 0.0159), there was no difference in patients recorded as ASA physical status 2, 3 or 4/5 between centres with and without CPET (ASA 2 RR 0.97, 95%CI 0.95–1.0, p = 0.067; ASA 3 RR 0.96, 95%CI 0.91–1.01, p = 0.090; ASA 4/5 RR 0.87, 95%CI 0.73–1.04, p = 0.126). National Bowel Cancer Audit data are real-world data that are freely available for analysis and characterises routine clinical practice. Our analysis of this dataset suggests an association between better outcomes and centres that have CPET, which warrants further scrutiny. Exercise-oncology research is expanding and CPET-based prehabilitation has potential to improve outcomes after cancer surgery. Current data submission to the National Bowel cancer Audit includes patient-level CPET data and we would encourage the auditors to describe and refine further any correlation between CPET and outcomes after major colorectal cancer surgery in future reports." @default.
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• W2897919049 date "2018-10-08" @default.
• W2897919049 modified "2023-09-26" @default.
• W2897919049 title "Bowel cancer surgery outcomes and pre‐operative cardiopulmonary exercise testing: insights from real‐world data" @default.
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• W2897919049 doi "https://doi.org/10.1111/anae.14459" @default.
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