Stair Climbing Test Predicts Cardiopulmonary Complications After Lung Resection

doi:10.1378/chest.121.4.1106

Chest

Volume 121, Issue 4, April 2002, Pages 1106-1110

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Study objective

To evaluate the capability of the stair climbing test to predict cardiopulmonary complications after lung resection for lung cancer.

Design

A prospective cohort of candidates for lung resection. Spirometric assessment and the stair climbing test were performed the day before operation. Univariate and multivariate analyses were performed to identify predictors of postoperative complications.

Setting

Tertiary referral center.

Patients

A consecutive series of 160 candidates for lung resection with lung carcinoma from January 2000 through March 2001.

Results

At univariate analysis, the patients with complications were significantly older (p = 0.02), had a significantly lower FEV₁ percentage (p = 0.007) and predicted postoperative FEV₁ percentage (p = 0.01), had a greater incidence of a concomitant cardiac disease (p = 0.02), climbed a lower altitude at the stair climbing test (p < 0.0001), and had a lower calculated maximum oxygen consumption ( $\dot{V}$ o₂max) [p = 0.03] and predicted postoperative $\dot{V}$ o₂max (p = 0.006) compared to the patients without complications. At multivariate analysis, the altitude reached at the stair climbing test remained the only significant independent predictor of complications.

Conclusions

The stair climbing test is a safe and economical exercise test, and it was the best predictor of cardiopulmonary complications after lung resection.

Section snippets

Materials and Methods

One hundred sixty-six candidates for lung resection for non-small cell lung carcinoma from January 2000 through March 2001 were prospectively enrolled in the present analysis after giving informed consent. Six patients were excluded from the study: three patients for severe musculoskeletal disease and three patients for peripheral vascular disease. The remaining 160 patients (128 men and 32 women) formed the database of the analysis. Twenty-eight pneumonectomies, 111 lobectomies, and 21

Results

Twenty-two patients in our series (13.8%) had 25 cardiopulmonary complications: pneumonia (n = 7), arrhythmia (n = 7), cardiac failure (n = 3), respiratory insufficiency (n = 3), pulmonary edema (n = 1), atelectasis (n = 1), and death (n = 3). The mean stair climbing test duration was 114.1 s (± 28.1 s). No patient experienced significant cardiac arrhythmia or other complications of the test. All 160 patients enrolled in the present study who performed the stair climbing test underwent surgery

Discussion

Exercise tests are regarded as global tests, capable of uncovering severe pathophysiologic abnormalities in the oxygen transport system. Those patients who cannot generate high oxygen consumption ( $\dot{V}$ o₂) on preoperative exercise testing may be similarly unable to do so in response to the hypermetabolic demands imposed by major surgery or its complications.¹⁶

Stair climbing is an economical and widely applicable test, and it has an honored tradition among thoracic surgeons.² The appeal of

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Clinical InvestigationsEXERCISEStair Climbing Test Predicts Cardiopulmonary Complications After Lung Resection

Study objective

Design

Setting

Patients

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

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Surg Clin N Am

Chest

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Ann Thorac Surg

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Ann Thorac Surg

Clin Chest Med

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Ann Thorac Surg

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Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Clinical Investigations
EXERCISE
Stair Climbing Test Predicts Cardiopulmonary Complications After Lung Resection