Influence of preoperative exercise capacity on length of stay after thoracic cancer surgery.
BACKGROUND
Stress testing is frequently used to assess cardiac risk before thoracic surgery. However, the relationship between treadmill exercise capacity and length of stay (LOS) has not been investigated. We hypothesized that exercise capacity, a strong predictor of long-term prognosis, can also predict LOS after thoracic cancer surgery.


METHODS
Accordingly, 191 consecutive patients who had exercise stress testing before major thoracic cancer surgery were retrospectively grouped by poor (<4 metabolic equivalents [METs], n = 31), fair (4 to 7 METs, n = 107), good (7 to 10 METs, n = 30), and excellent (>10 METs, n = 23) exercise capacity. The relationship between exercise capacity and LOS was then determined.


RESULTS
Average LOS was inversely related to exercise capacity, with a nearly twofold increase in LOS between the excellent and poor exercise groups (4.8 versus 9.2 days). This relationship remained significant even after controlling for operation type, history of dyspnea, sex, and smoking history in analysis of covariance. Prolonged hospital stay (10 days or more) was strongly predicted by exercise capacity. Failure to exceed 4 METs was associated with a high risk of prolonged stay (9 of 31, 39%), whereas none of the 23 patients who exceeded 10 METs had a prolonged stay.


CONCLUSIONS
Treadmill exercise capacity has independent predictive value for LOS and risk of prolonged stay after thoracic cancer surgery. These findings have important implications for risk assessment and cost, suggesting that preoperative programs designed to improve exercise capacity may favorably influence LOS and associated costs.
Weinstein
Howard
H
Department of Medicine, Division of Cardiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. weinsteh@mskcc.org
Bates
Andrew T
AT
Spaltro
Barbara E
BE
Thaler
Howard T
HT
Steingart
Richard M
RM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures