title: Patients who do not reach a distance of 500 m during the 6-min walk test have an increased risk of postoperative complications and prolonged hospital stay after lobectomy.
abstract: OBJECTIVE
  Exercise testing is an additional tool to standard pulmonary assessment before radical pulmonary resection in lung cancer patients. Evidence is lacking, supporting the significance of routine implementation of these simple physiological tests in preoperative evaluation.
  
  
  METHODS
  Between April 2009 and October 2011, 253 lung cancer patients, who underwent lobectomy in a single institution, were entered into this study. All of the patients were accepted for resection based on a standard evaluation protocol. Additionally on the day before the surgery, patients performed a 6-min walk test (6MWT). Patients were categorized, depending on the result of 6MWT, in order to stratify their risk of postoperative complications. Threshold values of 6MWT were assessed on the basis of maximum area under ROC curves.
  
  
  RESULTS
  There were 148 men and 105 women with a mean age of 63 years. All patients underwent lobectomies due to primary lung cancer. A distance of 500 m and 100% of the predicted 6MWT were taken as threshold values differentiating risk of postoperative complications. The cut-off value of 500 m separates individuals with an increased risk of postoperative complications [60.6 vs 36.9%, odds ratio (OR): 2631; 95% confidence interval (CI): 1.423-4.880] and prolonged hospitalization (7 vs 6 days). By applying a cut-off value of 500 m, the higher incidence of atrial fibrillation (21.2 vs 11.7%; OR: 2019; 95% CI: 0.904-4.484) and higher requirement for blood transfusion (18.1 vs 9.0%; OR: 2222; 95% CI: 0.928-5.289) fairly reached the level of significance. There were no early postoperative deaths in the analysed groups.
  
  
  CONCLUSIONS
  Patients who walk <500 m during the 6MWT before lobectomy have an increased risk of postoperative complications and prolonged hospital stay.
authors.affiliation: Thoracic Surgery Department, Medical University of Gdansk, Gdansk, Poland marjanski@gumed.edu.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Marjanski
authors.affiliation: Department of Physiotherapy, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Damian
authors.initials: D
authors.lastname: Wnuk
authors.affiliation: Thoracic Surgery Department, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Damian
authors.initials: D
authors.lastname: Bosakowski
authors.affiliation: Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Szmuda
authors.affiliation: Department of Anaesthesiology and Intensive Care, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Wioletta
authors.initials: W
authors.lastname: Sawicka
authors.affiliation: Thoracic Surgery Department, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Rzyman
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects*; D011044:Poland / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016138:Walking / Q000502:physiology*
keywords: Complication; Lobectomy; Lung cancer; Risk assessment