Symptom-Limited Stair Climbing as a Predictor of Postoperative Cardiopulmonary Complications After High-Risk Surgery

doi:10.1378/chest.120.4.1147

Chest

Volume 120, Issue 4, October 2001, Pages 1147-1151

https://doi.org/10.1378/chest.120.4.1147 Get rights and content

Study objective

Thoracotomy, sternotomy, and upper abdominal laparotomy are associated with high rate of postoperative cardiopulmonary complications (POCs). We hypothesized that symptom-limited stair climbing predicts POCs after high-risk surgery.

Design

A prospective evaluation of 83 patients undergoing thoracotomy, sternotomy, and upper abdominal laparotomy surgery.

Methods

The 52 men and 31 women completed symptom-limited stair climbing. A separate investigator, blinded to the number of flights of stairs climbed, assessed 30-day actual outcomes for POCs, including pneumonia, atelectasis, mechanical ventilation for > 48 h, reintubation, myocardial infarction, congestive heart failure, arrhythmia, pulmonary embolus, and death within 30 days of surgery. The operations performed included 31 lobectomies, 6 wedge resections, 3 pneumonectomies, 3 substernal thymectomies, 1 substernal thyroidectomy, 23 colectomies, 3 laparotomies, 7 abdominal aortic aneurysm repairs, 5 esophagogastrectomies, and 1 nephrectomy.

Results

POCs occurred in 21 of 83 patients (25%) overall, in 9 of 44 patients undergoing thoracotomy/sternotomy (20%), and in 12 of 39 patients undergoing upper abdominal laparotomy (31%). Of those unable to climb one flight of stairs, 89% developed a POC. No patient able to climb the maximum of seven flights of stairs had a POC. The inability to climb two flights of stairs was associated with a positive predictive value of 82% for the development of a POC. The number of days in the hospital postoperatively decreased with a patient's increased ability to climb stairs.

Conclusions

Symptom-limited stair climbing offers a simple, inexpensive means to predict POCs after high-risk surgery.

Section snippets

Patient Selection

Randomly selected patients undergoing surgery between March 1994 and April 1998 were identified in an outpatient testing center or on the inpatient service. The surgery types included thoracotomy, sternotomy, and upper abdominal laparotomy. Surgery was performed by seven surgeons who were aware of our prospective study. No patient was denied surgery on the basis of our preoperative testing. No patient underwent lung resection in whom the postoperative predicted FEV₁ was < 800 mL or 40%. All

Results

Thirty-one women and 52 men between the ages of 39 and 84 years were included in the study. Twenty-one of 83 patients (25%) experienced at least one POC (Table 1). Five patients experienced both cardiac and pulmonary complications. There were 25 pulmonary complications, 9 cardiac complications, and 3 deaths. One death was a sudden cardiopulmonary arrest in a 70-year-old woman (climbed four flights of stairs) 13 days after undergoing a lobectomy complicated by staphylococcal pneumonia. Another

Discussion

In a diverse group of patients undergoing high-risk surgery, we found that symptom-limited stair climbing was predictive of POCs and length of hospital stay. The positive predictive value of the inability to climb three flights of stairs was similar for both the thoracic surgical group and the group undergoing upper abdominal laparotomies, indicating that the tool may be useful for patients undergoing each type of surgery. The ability of stair climbing to predict the length of hospital stay was

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Clinical InvestigationsSurgerySymptom-Limited Stair Climbing as a Predictor of Postoperative Cardiopulmonary Complications After High-Risk Surgery

Study objective

Design

Methods

Results

Conclusions

Section snippets

Patient Selection

Results

Discussion

J Thorac Cardiovasc Surg

Ann Thorac Surg

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Thorac Cardiovasc Surg

Clinical Investigations
Surgery
Symptom-Limited Stair Climbing as a Predictor of Postoperative Cardiopulmonary Complications After High-Risk Surgery