Original articleGeneral thoracicPerformance at Symptom-Limited Stair-Climbing Test is Associated With Increased Cardiopulmonary Complications, Mortality, and Costs After Major Lung Resection
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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