title: Inability to perform maximal stair climbing test before lung resection: a propensity score analysis on early outcome.
abstract: OBJECTIVE
  The objective of the present study was to assess whether patients unable to perform a preoperative maximal stair climbing test had an increased incidence of morbidity and mortality after major lung resection compared to patients who were able to exercise.
  
  
  METHODS
  Three hundred and ninety one patients submitted to pulmonary lobectomy or pneumonectomy for lung cancer were analyzed. Forty-five of these patients were unable to perform a preoperative maximal stair climbing test for underlying comorbidities. Unadjusted and propensity score case matched comparisons were performed between patients who could and who could not perform a preoperative stair climbing test. Multi-variable analyses were then performed to identify predictors of morbidity and mortality, and were validated by bootstrap bagging.
  
  
  RESULTS
  Patients who could not perform the stair climbing test had similar morbidity rates (31.1 vs. 35.6%, respectively, P=0.7), but higher mortality rates (15.6 vs. 4.4%, respectively, P=0.08) and deaths among complicated patients (50 vs. 12.5%, respectively, P=0.025), compared to propensity score matched patients who could perform the stair climbing test. Logistic regression analyses showed that the inability to perform the stair climbing test was an independent and reliable predictor of mortality (P=0.005) but not of morbidity (P=0.2).
  
  
  CONCLUSIONS
  Patients unable to perform a preoperative maximal exercise test had an increased risk of mortality after major lung resection. Half of these patients did not survive postoperative complications, due to their decreased aerobic reserve caused by physical inactivity which made them unable to cope with the increased oxygen demand.
authors.affiliation: Unit of Thoracic Surgery, Department of Respiratory Diseases, Umberto I Regional Hospital, Ancona, Italy. alexit_2000@yahoo.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.forename: Armando
authors.initials: A
authors.lastname: Sabbatini
authors.forename: Francesco
authors.initials: F
authors.lastname: Xiume'
authors.forename: Alessandro
authors.initials: A
authors.lastname: Borri
authors.forename: Michele
authors.initials: M
authors.lastname: Salati
authors.forename: Rita Daniela
authors.initials: RD
authors.lastname: Marasco
authors.forename: Aroldo
authors.initials: A
authors.lastname: Fianchini
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D002423:Cause of Death; D000075202:Contraindications; D004812:Epidemiologic Methods; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome