Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery.
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.


METHODS
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.
Girish
M
M
Division of Pulmonary and Critical Care Medicine, Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
Trayner
E
E
Dammann
O
O
Pinto-Plata
V
V
Celli
B
B
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008171:Lung Diseases / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D018570:Risk Assessment; D016019:Survival Analysis; D013908:Thoracotomy