Predicting critical incidents development during elective surgery

Aim. The evaluate the possibility of predicting critical incidents development during elective surgery using Duke University activities of daily living questionnaire, a six-minute walk test, cardiopulmonary exercise testing.

Methods. 36 patients who had undergone elective abdominal surgery were included in the study. To determine the functional state in preoperative period patients filled in Duke University activities of daily living questionnaire, performed a 6-minute walk test, cardiopulmonary exercise testing. Critical incidents analysis was conducted by E.A. Kazakova method (2005) at two stages: induction and maintenance of anesthesia. Using statistical methods the most informative indicators for predicting critical incidents were determined.

Results. Logistic regression analysis demonstrated that only the anaerobic threshold and 6-minute walk test significantly contributed to predicting critical incidents. At the same time, ROC-analysis demonstrated the predictive value of using only the anaerobic threshold to determine the likelihood of critical incidents. It was found that this indicator threshold value is 10.85 ml/kg per minute with 100% sensitivity and 95% specificity. It is also proved that the patients’ subjective assessment leads to an overestimation of their functional state.

Conclusion. Anaerobic threshold indicator determined by a cardiopulmonary exercise testing can be used as a criterion for predicting critical incidents development; reduction in the anaerobic threshold of less than 10.85 mL/kg per minute indicates the likelihood of critical incidents development with a high level of sensitivity and specificity.