Prediction of cardiac and pulmonary complications related to elective

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    abdominal and noncardiac thoracic surgery in geriatric patients.
Gerson-MC; Hurst-JM; Hertzberg-VS; Baughman-R; Rouan-GW; Ellis-K
Department of Internal Medicine, University of Cincinnati Medical Center
Am-J-Med. 1990 Feb; 88(2): 101-7

  PURPOSE: Major cardiac and pulmonary complications associated with
  abdominal and noncardiac thoracic surgery are a common cause of
  mortality and serious morbidity in elderly patients. We postulated
  that a simple, inexpensive bicycle exercise test could provide
  objective documentation of cardiopulmonary reserve and, therefore,
  predict perioperative pulmonary as well as cardiac complications.
  PATIENTS AND METHODS: Prior to elective surgery, 177 patients aged 65
  years or older had assessment of the clinical history, results of
  physical examination, electrocardiogram, chest radiograph, blood
  chemistries, pulmonary function test findings, supine exercise test
  results, Dripps classification, and Goldman cardiac risk factors.
  Observations in patients with and without major perioperative cardiac
  and/or pulmonary complications were compared using univariate
  analysis followed by a multivariate logistic regression procedure.
  RESULTS: Major perioperative complications were pulmonary in 24
  patients, cardiac in 25 patients, and either cardiac or pulmonary in
  39 patients. By multivariate analysis, inability to perform two
  minutes of supine bicycle exercise raising the heart rate above 99
  beats/minute was the best predictor of perioperative pulmonary,
  cardiac, and combined cardiopulmonary complication (p less than
  0.0005). Among 108 patients who were able to achieve these exercise
  criteria, cardiac or pulmonary complications occurred in 10 patients
  (9.3%), with one death (0.9%). Among 69 patients unable to exercise
  satisfactorily, cardiac or pulmonary complications occurred in 29
  patients (42%), with five total deaths (7.2%). CONCLUSION: Objective
  measurement of exercise capacity by supine bicycle ergometry appears
  to be of clinical value for preoperative risk stratification for both
  pulmonary and cardiac complications prior to major elective abdominal
  or noncardiac thoracic surgery in elderly patients.