Original article
General thoracic
Performance at Symptom-Limited Stair-Climbing Test is Associated With Increased Cardiopulmonary Complications, Mortality, and Costs After Major Lung Resection

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 27–29, 2008.
https://doi.org/10.1016/j.athoracsur.2008.03.025Get rights and content

Background

Exercise tests are increasingly used during preoperative evaluation before lung resection. This study assessed the association between performance at the symptom-limited stair-climbing test and postoperative cardiopulmonary morbidity, mortality, and costs after major lung resections.

Methods

As part of their routine preoperative evaluation, 640 patients who had lobectomy (n = 533) or pneumonectomy (n = 107) for lung cancer from January 2000 through April 2007 performed a preoperative symptom-limited stair-climbing test. Sensitivity/specificity analysis was used to identify the best cutoff values of altitude climbed (number of steps × height of the step in m) associated with outcome. Univariate and multivariate regression analyses (validated by bootstrap) were used to test associations between preoperative and operative factors and postoperative cardiopulmonary complications, mortality, and postoperative costs.

Results

The altitude reached at the stair-climbing test was reliably associated with increased cardiopulmonary complications (p = 0.04), mortality (p = 0.02), and costs (p < 0.0001). In patients who climbed less than 12 m, cardiopulmonary complications, mortality, and costs were 2-fold (p < 0.0001), 13-fold (p < 0.0001), and 2.5-fold higher, respectively, than in patients who climbed more than 22 m.

Conclusions

Performance at a maximal stair-climbing test was reliably associated with postoperative morbidity and mortality. We recommend the use of this simple and economic test in all lung resection candidates. Patients who perform poorly at the stair-climbing test should undergo a formal cardiopulmonary exercise test with measurement of oxygen consumption to optimize their perioperative management.

Section snippets

Patients and Methods

We analyzed 640 consecutive patients undergoing major lung resections, including 533 lobectomies/bilobectomies and 107 pneumonectomies, at our institution from January 2000 through April 2007. All patients performed a preoperative symptom-limited stair-climbing test as part of their routine functional evaluation. During the same period, another 90 patients who underwent major lung resections did not perform a stair-climbing test or any other exercise tests for severe underlying incapacitating

Results

The characteristics of the patients analyzed in this study are reported in Table 2. Cardiopulmonary morbidity was 23.4% (n = 150) and mortality was 3.3% (n = 21).

Compared with patients without complications, those with complications were older (p < 0.0001), had lower values of ppoFEV1 (p = 0.0001), ppoDlco (p = 0.0003), and altitude reached at stair climbing (p = 0.001), and had an increased incidence of cardiac comorbidity (p < 0.0001) and pneumonectomy (p = 0.01; Table 3). The morbidity rate

Comment

Exercise tests are regarded as global tests capable to uncover deficits in the oxygen transport system. Patients with reduced aerobic reserve may be unable to cope with the increased oxygen demand typically occurring in the postoperative period. In case of major complications, this unbalance may determine a protracted oxygen debt, and as a consequence, a multiorgan failure may ensue [18]. Exercise tests may thus simulate the surgical stress and detect potential defects in the

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