Conclusions
These findings highlight the interpretive limitations associated with
the subjective assessment of patient frailty with surgical risk
classification underestimated in up to a third of patients compared to
the more objective validated assessment of post-operative outcomes via
CPET-derived CRF. For ‘high-stakes’ open TAAA surgery, the integration
of CPET can improve perioperative risk assessment though further
research is required to identify ‘lower limits’ of CRF below which
operative intervention may be considered prohibitively risky. Surgeons
also need to consider (pre-operative) exercise training as a modifiable
component of multimodal prehabilitation strategies with the potential to
augment CRF, reduce surgical risk and thus improve outcome.