Value of preoperative 6-minute walk test for predicting postoperative pulmonary complications

Keeratichananont, Warangkana; Thanadetsuntorn, Chokchai; Keeratichananont, Suriya

doi:10.1177/1753465815615509

Cited by 60 publications

(36 citation statements)

References 32 publications

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“…These findings are similar to those of Lee et al 2013, however they were related to medical morbidity only, whereas these results relate to both medical and surgical morbidity. Previous studies have given a cut of points of <300m as associated with morbidity (Awdah et al 2015) and <325m as associated with PPC's (Keeratichananont et al 2016). However, the findings of this study show a median of 490m in the complications group which is higher than the previously mentioned studies.…”

Section: Six Minute Walk Testcontrasting

confidence: 81%

Physical function performance and recovery of patients undergoing abdominal surgery in relation to post-operative complications–A prospective real world study

Flahive¹,

Driscoll²,

Broderick³

2018

Physiotherapists

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Objective: The primary aim of the study is to evaluate the physical function performance differences between those who develop complications and those who do not and determine their impact on recovery. Background: Complication rates in abdominal (colorectal, hernia repair & cholecystectomies) surgery are variable and appear to be lower in minimally invasive, less complex surgery. Complications are associated with significant costs in terms of morbidity, finance, psychological and impact on recovery. Factors that have been identified as associated with complications include age, BMI, surgical approach, co-morbidities, American Society of Anaesthesiologists (ASA) status, physical function frailty and level of dependency. It is also clear that these factors individually are unlikely predictors but highlight the need for multifactorial assessment. Surgical procedures in their essence cause significant physiological stress which can often mimic similar physiological effects of exercise. Cardiopulmonary exercise testing (CPET) can be useful in predicting complications, however is generally unavailable and not always suitable. No one measure has been identified to predict complications in an abdominal surgery population, hence the need to evaluate physical function performance as a whole and analyse differences that may emerge between those who develop complications and those who do not. Methods: Participants were recruited (n = 49) via the pre-operative assessment unit in the University Hospital Limerick. Pre-operative assessment included the following: demographics data, six-minute walk distance, VO2Peak, spirometry, peak cough flow, self-reported activity using the International Physical Activity Questionnaire (IPAQ), ASA score, surgical Physical function performance and recovery of patients undergoing abdominal surgery in relation to complications-A prospective real world study-4-grade, Malnutrition Universal Scoring Tool (MUST) score, albumin and creatinine levels. Post-surgery data included surgery type, length, surgical approach, initial 24-hour pain relief, length of stay and complications. At 30 and 60 days, participants were contact via telephone and the telephone IPAQ repeated, questioned regarding their self-assessed physical recovery and post hospital discharge complications. Results: Surgery types fell into the following 4 categories: colorectal (n = 21), colorectal reversals (n = 7), hernia repairs (n = 10) and cholecystectomies (n = 5). The complications rate was 41.9% (n=18) pre-discharge, 30.2% (n=13) at 30 day's post-surgery and 21% (n = 9) at 60 day's post-surgery. Obesity (P=0.005*), longer operating time (P=0.05*), >2 co-morbidities (P = 0.033*), low activity levels (P=0.020*), low VO2Peak (P=0.017*) and lower 6-minute walk distance (P=0019*) were statistically different between complications and non-complications groups with worse scores seen in the complications group. Length of stay was significantly increased in the complications groups at a median of 8.5 nights versus 2 nights in the non-compl...

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Section: Six Minute Walk Testcontrasting

confidence: 81%

Physical function performance and recovery of patients undergoing abdominal surgery in relation to post-operative complications–A prospective real world study

Flahive¹,

Driscoll²,

Broderick³

2018

Physiotherapists

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“…7,8 Evidence regarding the ability of the 6MWT to predict patient outcomes in the perioperative setting is limited to cohort studies with sample sizes of approximately 100 patients. In patients having thoracic or major general surgery, the 6MWT distance was predictive of postoperative complications 7,9,10 and hospital length of stay 10,11 in some but not all studies, 12 and was predictive of mortality in patients undergoing bilateral lung volume reduction surgery for severe chronic airways disease. 11 Its ability to predict cardiovascular or patientcentred outcomes in a large surgical cohort is not known.…”

mentioning

confidence: 98%

Using the 6-minute walk test to predict disability-free survival after major surgery

Shulman

Cuthbertson

Wijeysundera

et al. 2019

British Journal of Anaesthesia

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Background: The 6-min walk test (6MWT) is a common means of functional assessment. Its relationship to disability-free survival (DFS) is uncertain. Methods: This sub-study of the Measurement of Exercise Tolerance for Surgery study had co-primary outcome measures: correlation of the preoperative 6MWT distance with 30 day quality of recovery (15-item quality of recovery) and 12 month WHO Disability Assessment Schedule scores. The prognostic utility of the 6MWT and other risk assessment tools for 12 month DFS was assessed with logistic regression and receiver-operating-characteristic-curve analysis. Results: Of 574 patients recruited, 567 (99%) completed the 6MWT. Twelve months after surgery, 16 (2.9%) patients had died and 444 (77%) had DFS. The 6MWT correlated weakly with 30 day 15-item quality of recovery (r¼0.14; P¼0.001) and 12 month WHO Disability Assessment Schedule (r¼e0.23; P<0.0005) scores. When the cohort was split into 6MWT distance tertiles, the adjusted odds ratio of low vs high tertiles for DFS was 3.13 [95% confidence interval (CI): 1.54e6.35]. The only independent variable predictive of DFS was the Duke Activity Status Index (DASI) score (adjusted odds ratio: 1.06; P<0.0005). The area under the receiver-operating-characteristic curve for DFS was 0.63 (95% CI: 0.57e0.70) for the 6MWT, 0.60 (95% CI: 0.53e0.67) for cardiopulmonary-exercise-testing-derived peak oxygen consumption, and 0.70 (95% CI: 0.64e0.76) for the DASI score. Conclusions: Of the risk assessment tools analysed, the DASI was the most predictive of DFS. The 6MWT was safe and comparable with cardiopulmonary exercise testing for all predictive assessments. Future research should aim to determine the optimal 6MWT distance thresholds for risk prediction.

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“…However, there is considerable evidence suggesting that patients with poor exercise test results are at an increased risk for PRCs after major surgery [13][14][15] , probably due to the ability of exercise testing to determine the subject's physiological ability to cope with the demands placed on the cardiorespiratory system following the surgical procedure [16] . A major feature of 6 MWT is the identification of oxyhemoglobin desaturation associated with pulmonary disease, which may not be apparent when the subject is assessed in the resting state.…”

mentioning

confidence: 99%

Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Liver Transplantation

Magalhães¹,

Nogueira²,

Marinho³

et al. 2017

Respiration

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Background: Postoperative respiratory complications (PRCs) are common after liver transplantation (LT) and contribute significantly to the related morbidity and mortality. Objective: The aim of this paper was to determine the incidence of PRCs after LT and the value of simple exercise capacity measures as independent predictors of PRCs. Methods: We conducted a prospective cohort study of consecutive adults submitted to LT at a University Hospital in Fortaleza Brazil from March 2013 to March 2015. At baseline, exercise capacity was assessed with the 6-minute walk test (6MWT) and the 6-minute step test (6MST), lung function was tested by spirometry, and respiratory muscle strength was measured by maximal respiratory pressure. Additional relevant pre- and intraoperative data were collected through interview and chart review, and their association with the incidence of PRCs was evaluated. Results: The study included 100 subjects, 44% of whom presented at least 1 of the PRCs. In the univariate analysis, poor 6MST and 6MWT results and a longer preoperative cold ischemia time were associated with PRCs. The logistic regression analysis showed that PRCs were less likely to occur when preoperative walking distances were longer: the odds ratio (95% CI) was reduced to 0.589 (0.357-0.971) for each 50 m walked (p = 0.03). Likewise, PRCs were more likely to occur in patients with longer preoperative cold ischemia times: the odds ratio (95% CI) increased to 1.008 (1.002-1.015) for each minute (p = 0.01). Conclusion: The incidence of PRCs is high in LT patients. A prolonged cold ischemia time and preoperative 6MWT results were independent predictors of PRCs in this patient population.

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Value of preoperative 6-minute walk test for predicting postoperative pulmonary complications

Abstract: Preoperative 6MWT is a very useful alternative test for predicting PPC in high risk patients scheduled to undergo surgery under GA.

Cited by 60 publications

References 32 publications

Physical function performance and recovery of patients undergoing abdominal surgery in relation to post-operative complications–A prospective real world study

Physical function performance and recovery of patients undergoing abdominal surgery in relation to post-operative complications–A prospective real world study

Using the 6-minute walk test to predict disability-free survival after major surgery

Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Liver Transplantation

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