Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study

Darwen, C; Bryan, A; Quraishi-Akhtar, T; Moore, J

doi:10.1016/j.bjao.2023.100124

Perioperative medicine & outcomes

Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study

BJA OpenPublished 23 Feb 2023Retrospective cohort study

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Authors' conclusion

Our study suggests that postoperative hyperlactataemia and preoperative poor V̇E/V̇co2 are independently associated with an increased risk of mortality after major noncardiac surgery.

Study context

Population: Patients undergoing major noncardiac surgery with preoperative cardiopulmonary exercise testing (CPET) and postoperative lactate measurements, tertiary UK centre, 2007–2014analysed
Participants: 1,075 patients

Exposure: Postoperative hyperlactataemia and preoperative poor V̇E/V̇co2 vs not
Outcome: Mortality
Follow-up: 30 days

Methodological detailssingle-centre, tertiary UK centre

Single-centre
Tertiary UK centre

Main finding

As reported in the abstract

30-day mortality by mean postoperative lactate >2 mM

Lactate >2 mM vs Lactate ≤2 mMOdds ratio (95% CI)P value

First 12 h

3.9(2.1–7.3)

P < 0.005

First 24 h

4.5(2.4–8.4)

P < 0.005

First 48 h

6.1(3.3–11.5)

P < 0.005

Observational data: associations, not effects.

Further findings

30-day mortality by preoperative CPET V̇E/V̇co2 (dichotomous, cut-off 34)

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
V̇E/V̇co2 (cut-off 34)Associated with increased risk	0.20.5125	2.5 (1.3–4.8)	P < 0.005
	0.20.5125Odds ratio (log scale)

30-day mortality, combined hyperlactataemia in first 24 h (cut-off 2 mM) and preoperative V̇E/V̇co2

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
Hyperlactataemia first 24 h + V̇E/V̇co2Combined effect	0.050.21520	11.53 (4.6–28.8)	P ≤ 0.005
	0.050.21520Odds ratio (log scale)

30- and 90-day mortality, multivariable model (adjusted for age, BMI, surgical risk)

Hyperlactataemia and poor V̇E/V̇co2 retained significant associations with 30- and 90-day mortality

Original publication

Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study. BJA Open. Published 23 February 2023. doi:10.1016/j.bjao.2023.100124

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