JMIR Publications

ABSTRACT

Background:

Precise functional capacity assessment is a critical component for preoperative risk stratification and current provider-driven estimation has poor sensitivity. It is unclear if brief submaximal cardiopulmonary exercise testing can be implemented in an efficient manner in a high-volume pre-surgical evaluation clinic, if so, this may enhance precision of estimation of functional capacity.

Objective:

We tested the logistic feasibility of integrating brief submaximal cardiopulmonary exercise testing (smCPET) in a high-volume pre-surgical evaluation (PSE) clinic setting. We measured feasibility endpoints of 1) operational efficiency as measured by length of time of experimental session < 20 minutes, 2) no more than moderate perceived physical exertion as quantified by a modified Borg survey of perceived exertion of <7 in the absence of observed complications, 3) high participant satisfaction with smCPET task execution, represented as a score of >8, and 4) high patient satisfaction with scheduling of smCPET testing, represented as a score of >8.

Methods:

After institutional approval, we screened enrolled 43 participants who met eligibility criteria of i) age > 60 years old, ii) revised cardiac risk index of <2, iii) self-reported metabolic equivalents (METs) of >4.6 (i.e. ability to climb 2 flights of stairs), and iv) presenting for noncardiac surgery. Pre-intervention self-reported METs, Duke Activity Status Index (DASI) surveys, a 6-minute smCPET trial, Borg survey of perceived exertion, and post-intervention survey were performed.

Results:

Session time was 16.9 minutes (±6.8). Post-test modified Borg survey was 5.35 (±1.8), corresponding to moderate perceived exertion. Median (IQR) patient satisfaction [on a scale of 1 (worst) to 10 (best)] was 10 (10,10) for scheduling and 10 (9, 10) for task performance. Operational efficiency was achieved within 15 experimental sessions.

Conclusions:

Session time was 16.9 minutes (±6.8). Post-test modified Borg survey was 5.35 (±1.8), corresponding to moderate perceived exertion. Median (IQR) patient satisfaction [on a scale of 1 (worst) to 10 (best)] was 10 (10,10) for scheduling and 10 (9, 10) for task performance. Operational efficiency was achieved within 15 experimental sessions. Clinical Trial: This clinical trial was registered prior to participant enrollment. ClinicalTrials.gov Registration: #NCT05743673. Principal Investigator: Zyad J. Carr, M.D. Date of Registration: 5-12-2023.