Chest
Clinical InvestigationsSurgerySymptom-Limited Stair Climbing as a Predictor of Postoperative Cardiopulmonary Complications 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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