Discussion
By comparing subjective clinical evaluation of a patient’s risk by
experienced clinicians against the more objective validated assessment
of post-operative outcomes via CPET, the present study has identified
two important findings. First, we identified clear disagreement between
subjective assessments of risk with a third of patients classified not
frail considered unfit by notes review and almost nine out of ten
patients suffering from mild to severe disease by ASA classification.
Second, and consistent with our original hypothesis, subjective
assessment underestimated surgical risk in up to a third of patients.
Collectively, these findings highlight the benefits of a more objective
and integrated approach offered by CPET that may help improve
perioperative risk assessment and direct care provision in patients
scheduled for ‘high-stakes’ open TAAA repair.