Performance at symptom-limited stair-climbing test is associated with increased cardiopulmonary complications, mortality, and costs after major lung resection.
BACKGROUND
Exercise tests are increasingly used during preoperative evaluation before lung resection. This study assessed the association between performance at the symptom-limited stair-climbing test and postoperative cardiopulmonary morbidity, mortality, and costs after major lung resections.


METHODS
As part of their routine preoperative evaluation, 640 patients who had lobectomy (n = 533) or pneumonectomy (n = 107) for lung cancer from January 2000 through April 2007 performed a preoperative symptom-limited stair-climbing test. Sensitivity/specificity analysis was used to identify the best cutoff values of altitude climbed (number of steps x height of the step in m) associated with outcome. Univariate and multivariate regression analyses (validated by bootstrap) were used to test associations between preoperative and operative factors and postoperative cardiopulmonary complications, mortality, and postoperative costs.


RESULTS
The altitude reached at the stair-climbing test was reliably associated with increased cardiopulmonary complications (p = 0.04), mortality (p = 0.02), and costs (p < 0.0001). In patients who climbed less than 12 m, cardiopulmonary complications, mortality, and costs were 2-fold (p < 0.0001), 13-fold (p < 0.0001), and 2.5-fold higher, respectively, than in patients who climbed more than 22 m.


CONCLUSIONS
Performance at a maximal stair-climbing test was reliably associated with postoperative morbidity and mortality. We recommend the use of this simple and economic test in all lung resection candidates. Patients who perform poorly at the stair-climbing test should undergo a formal cardiopulmonary exercise test with measurement of oxygen consumption to optimize their perioperative management.
Unit of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy. alexit_2000@yahoo.com
Alessandro
A
Brunelli
Majed
M
Refai
Francesco
F
Xiumé
Michele
M
Salati
Valeria
V
Sciarra
Laura
L
Socci
Armando
A
Sabbatini
D000368:Aged; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis