Implementation of Brief Submaximal Cardiopulmonary Testing in a High-Volume Presurgical Evaluation Clinic: Feasibility Cohort Study
Notice bibliographique
Résumé
Background Precise functional capacity assessment is a critical component for preoperative risk stratification. Brief submaximal cardiopulmonary exercise testing (smCPET) has shown diagnostic utility in various cardiopulmonary conditions. Objective This study aims to determine if smCPET could be implemented in a high-volume presurgical evaluation clinic and, when compared to structured functional capacity surveys, if smCPET could better discriminate low functional capacity (≤4.6 metabolic equivalents [METs]). Methods After institutional approval, 43 participants presenting for noncardiac surgery who met the following inclusion criteria were enrolled: aged 60 years and older, a Revised Cardiac Risk Index of ≤2, and self-reported METs of ≥4.6 (self-endorsed ability to climb 2 flights of stairs). Subjective METs assessments, Duke Activity Status Index (DASI) surveys, and a 6-minute smCPET trial were conducted. The primary end points were (1) operational efficiency, based on the time of the experimental session being ≤20 minutes; (2) modified Borg survey of perceived exertion, with a score of ≤7 indicating no more than moderate exertion; (3) high participant satisfaction with smCPET task execution, represented as a score of ≥8 (out of 10); and (4) high participant satisfaction with smCPET scheduling, represented as a score of ≥8 (out of 10). Student's t test was used to determine the significance of the secondary end points. Correlation between comparable structured surveys and smCPET measurements was assessed using the Pearson correlation coefficient. A Bland-Altman analysis was used to assess agreement between the methods. Results The mean session time was 16.9 (SD 6.8) minutes. The mean posttest modified Borg survey score was 5.35 (SD 1.8). The median patient satisfaction (on a scale of 1=worst to 10=best) was 10 (IQR 10-10) for scheduling and 10 (IQR 9-10) for task execution. Subjective METs were higher when compared to smCPET equivalents (extrapolated peak METs; mean 7.6, SD 2.0 vs mean 6.7, SD 1.8; t42=2.1; P<.001). DASI-estimated peak METs were higher when compared to smCPET peak METs (mean 8.8, SD 1.2 vs mean 6.7, SD 1.8; t42=7.2; P<.001). DASI-estimated peak oxygen uptake was higher than smCPET peak oxygen uptake (mean 30.9, SD 4.3 mL kg–1 min–1 vs mean 23.6, SD 6.5 mL kg–1 min–1; t42=7.2; P<.001). Conclusions Implementation of smCPET in a presurgical evaluation clinic is both patient centered and clinically feasible. Brief smCPET measures, supportive of published reports regarding low sensitivity of provider-driven or structured survey measures for low functional capacity, were lower than those from structured surveys. Future studies will analyze the prediction of perioperative complications and cost-effectiveness. Trial Registration ClinicalTrials.gov NCT05743673; https://clinicaltrials.gov/study/NCT05743673
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».