Original article: general thoracic
Stair climbing test as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly

https://doi.org/10.1016/S0003-4975(03)01327-4Get rights and content

Abstract

Background

The objective of this study was to assess the role of a symptom-limited stair climbing test in predicting postoperative cardiopulmonary complications in elderly candidates for lung resection.

Methods

A consecutive series of 109 patients more than 70 years of age who underwent pulmonary lobectomy for lung carcinoma from January 2000 through May 2003 formed the prospective database of this study. All patients in the analysis performed a preoperative symptom-limited stair climbing test. Univariate and multivariate analyses were performed to identify predictors of postoperative cardiopulmonary complications.

Results

At univariate analysis, the patients with complications had a lower forced expiratory capacity percentage of predicted (p = 0.048), predicted postoperative forced expiratory volume in 1 second percentage of predicted (p = 0.049), climbed a lower height at preoperative stair climbing test (p = 0.0004), and presented a greater proportion of cardiac comorbiditiy with respect to the patients without complications (p = 0.02). After logistic regression analysis, significant predictors of postoperative complications resulted in the presence of a concomitant cardiac disease (p = 0.04) and a low height climbed preoperatively (p = 0.0015).

Conclusions

A symptom-limited stair climbing test was a safe and simple instrument capable of predicting cardiopulmonary complications in the elderly after lung resection.

Section snippets

Patients and methods

One hundred and twenty-seven patients older than 70 years of age underwent pulmonary lobectomy for NSCLC from January 2000 through May 2003 and were prospectively enrolled in the present analysis after giving their informed consent. They represented 35.7% of all the patients operated on for lung cancer at our institution during the same period of time. Eighteen patients were excluded from the study because they were unable to perform the preoperative exercise test (8 for severe musculoskeletal

Results

Twenty-nine patients had cardiopulmonary complications (26.6%), 3 of whom died (2.7%).

Complications in order of frequency were pneumonia (12 cases), arrhythmia (12 cases), respiratory failure (two cases), pulmonary edema (two cases), acute myocardial infarction (one case), and cardiac failure (one case).

The mean stair climbing time duration was 115.1 seconds (± 30.6). No patients experienced significant cardiac arrhythmia or other complications of the test. All 109 patients enrolled in the

Comment

Due to a rise in life expectancy, thoracic surgeons are faced with a growing number of elderly patients presenting with a potentially resectable lung cancer. However, physiologic changes in the cardiovascular and respiratory systems and the increased frequency of underlying comorbidities increase the risk of life-threatening complications in these patients. Therefore, risk stratification is of utmost importance in these surgical candidates and may assist the surgeon in choosing the most

References (34)

  • P. Pate et al.

    Preoperative assessment of the high-risk patient for lung resection

    Ann Thorac Surg

    (1996)
  • M. Girish et al.

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

    Chest

    (2001)
  • F. Nagasaki et al.

    Complications of surgery in the treatment of carcinoma of the lung

    Chest

    (1982)
  • P.S. Romano et al.

    Patient and hospital characteristics related to in-hospital mortality after lung cancer resection

    Chest

    (1992)
  • R.L. Patel et al.

    Elective pneumonectomyfactors associated with morbidity and operative mortality

    Ann Thorac Surg

    (1992)
  • R.C. Morice et al.

    Exercise testing in the evaluation of patients at high risk for complications from lung resection

    Chest

    (1992)
  • I. Astrand

    Aerobic work capacity in men and women with special reference to age

    Acta Physiol Scand

    (1960)

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    Copyright © 2003 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.