LURE research project

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LURE research project

• Junaid Azam
• LURE Savile Scholar
• Third Year Medical Student

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LURE Savile Scholarship

• Leeds UndergraduateResearch Enterprise
• Aim nurture medical students with research
  ambitions and aspirations to become clinical
  academics
• Long-term commitment from Year 2 to Year 5
• Research project supervised by Dr Simon Howell
  and Professor Homer-Vanniasinkam

Photograph by Simon and Simon, UoL
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Why this particular research project?

• Is there an association between a patients
  VO2peak and their global quality of life after an
  open or endovascular repair of abdominal aortic
  aneurysm
• Interest in surgical research
• Innovative research project with little prior
  research in area of relating pre-operative
  functional capacity and post-operative QoL

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Cardiopulmonary exercise (CPX) testing
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CPX Testing

• Incremental exercise test with monitoring of ECG
  and gas exchange
• About 10 minutes
• 2 min at rest
• 2 min zero resistance
• Ramp to VO2peak
• gt2mm ST depression

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V-slope curve VCO2 against VO2
Arch Bronconeumol 2001 37 247 - 268
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Cardiopulmonary exercise (CPX) testing

• Patients functional capacity can be determined
  by CPX testing from
• Anaerobic Threshold AT (ml/kg/min)
• VO2peak (ml/kg/min)

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CPX testing and peri-operative mortality

• Older et al. (1999)
• Patients with VO2 at ATlt11ml/kg/min at higher
  risk of cardiac complications after surgery,
  especially if accompanied by IHD
• Other examples
• Jonathan Wilsons data from York Hospital(AT lt
  8.5 plus myocardial ischaemia)
• Thoracic surgery (British Thoracic
  Guidelines)(VO2peak lt15 ml/kg/min)

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Why carry out CPX testing?

• To assist patient and clinician decision making
• Plan the level of peri-operative care for the
  patient

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VO2peak and global QoL

• Association between functional status and QoL
  rather than mortality or risk for surgery
• Both continuous variables association examined
  by correlation between two variables
• No power calculation possible (no previous data)
  ? Pilot study

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Why take an interest in post-operative quality of
life?

• Clinical usefulness
• Plan proposed surgery
• Counsel the patient about the surgery
• Direct the use of resources
• Elucidate the natural history of postoperative
  recovery

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Determining post-operative QoL

• This study will use the following outcome
  measures
• Short form 36 (SF-36)
• Health Anxiety and Depression Scale (HADS)
• Post-Operative Morbidity Survey (POMS)

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SF-36

• Multi-purpose health survey with 36 questions
• 8-scale profile of functional health and
  well-being
• Gives an overall picture of the patients QoL

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SF-36 measurement model
www.sf-36.org
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HADS

• Consists of questions, seven for anxiety and
  seven for depression
• Each question is on a 4 point score
• Possible score ranges from 0-21 for anxiety and
  0-21 for depression

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Summary

• Association between VO2peak (CPX testing) and
  global QoL (SF-36)
• Pilot study minimal prior research
• Research could impact management of surgical
  patients and decisions about their suitability
  for surgery

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Any questions?