Performance at stair-climbing test is associated with postoperative complications after lung resection: a systematic review and meta-analysis

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>Thoracic surgery is the optimal treatment for early-stage lung cancer, but there is a high risk of postoperative morbidity. Therefore, it is necessary to evaluate patients’ preoperative general condition and cardiorespiratory capacity to determine the risk of postoperative complications. The objective of this study was to assess whether the stair-climbing test could be used in the preoperative evaluation of lung resection patients to predict postoperative morbidity following thoracic surgery.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed a systematic review and a meta-analysis on the association between stair-climbing test result and morbidity/mortality after thoracic surgery. We analysed all articles published until May 2020 in the following databases: Pubmed/Medline, Pedro, The Cochrane library, Embase and CINAHL. The risk of bias was assessed using the Quality in Prognosis Studies tool. This meta-analysis is registered as PROSPERO CRD42019121348.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>13 articles were included in the systematic review for a total of 2038 patients and 6 in the meta-analysis. There were multiple test evaluation criteria: rise time, height, desaturation and heart rate change. For the meta-analysis, we were able to pool data on the height of rise at a variable threshold: risk ratio 2.34 (95% CI 1.59 to 3.43) with I²=53% (p=0.06). The threshold for occurrence of complications was estimated at a 10 m climb.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results indicate that the stair-climbing test could be used as a first-line functional screening test to predict postoperative morbidity following thoracic surgery and that patients with a poor test result (&lt;10 m) should be referred to formal cardiopulmonary exercise testing.</jats:p></jats:sec>

The Use of Samsung Health and ECG M-Trace Base II Applications for the Assessment of Exercise Tolerance in the Secondary Prevention in Patients after Ischemic Stroke

“…As it has been proved in the studies by Johnson et al [ 24 ], Samsung Health is the most accurate application in detecting steps and energy expenditure during walking which affects the accuracy of the results obtained during SMWT and SCT. In line with the results of studies by Boujibar et al [ 27 ], fatigue and dyspnea were greater after performing SCT; however, those authors conducted their tests in a group of patients with lung cancer. The analysis of the available subject literature revealed that SCT has never been used in the post-stroke patients so far.…”

Association of performance in a stair-climbing test with complications and survival after lung cancer resection in the video-assisted thoracoscopic surgery era: population-based outcomes

“…With a high VATS rate of 88.2% during the last 5 years together with a segmentectomy rate of 33.9% in our population-based series, SCT can be used as a safe screening tool for a highly selective formal CPET. Therefore, in the VATS era, SCT can be relied on more widely in exercise testing, and the threshold for a poor test result and need for formal exercise testing could be set even below the recently recommended threshold of 10 m [ 5 ]. With a 9 m cut-off in this study, a trend of increased major morbidity rate in the poorer performance group (20.8% versus 10.0%) is evident.…”

“…Since during the test patients finished their climb after a full or half flight, there were no results for between 3 and 3.5 flights (or 10.6 m to 12.3). In this study, we used three flights of 10.6 m as a threshold for poor exercise capacity, being very close to a previously recommended level of 10 m [ 5 ]. Of 221 patients tested, 66 climbed this 10.6 m or less and formed the <11 m study group.…”

“…In the era of open lung cancer surgery, several studies have evaluated the role of SCT in the assessment of preoperative exercise capacity and complication risk. According to a recent review, SCT is able to predict complication [ 5 ]. In this review, the threshold for a poor result and referral to formal cardiopulmonary exercise testing was set at 10 m [ 5 ].…”

“…According to a recent review, SCT is able to predict complication [ 5 ]. In this review, the threshold for a poor result and referral to formal cardiopulmonary exercise testing was set at 10 m [ 5 ]. The role of SCT in the preoperative physiological assessment has, however, never been evaluated in the era of minimally invasive lung cancer surgery.…”