Relationship between the inability to climb two flights of stairs and outcome after major non‐cardiac surgery: implications for the pre‐operative assessment of functional capacity

Abstract

SummaryFunctional capacity is an integral component of the pre-operative evaluation of the cardiac patient for non-cardiac surgery. Stair climbing capacity has peri-operative prognostic importance. It may predict survival after lung resection and complications after major non-cardiac surgery. However, stair climbing cannot determine the aerobic metabolic capacity necessary to survive the peri-operative stress response. The potential benefits and current limitations of cardiopulmonary exercise testing to determine peri-operative aerobic capacity are discussed. Principles for the selection of an appropriate screening test of aerobic function are put forward.

Pre-operative pulmonary evaluation of lung cancer patients: a review of the literature

“…Another limitation of the stair climbing test is that it cannot estimate aerobic metabolic capacity adequately because stair climbing generally takes no more than 1 min. In addition, during the first minute of exercise oxygen-independent pathways play a role and oxidative phosphorylation only occurs after .1 min of exercise [85]. These limitations of the stair climbing test favour longer lasting exercise tests, such as the CPET or the shuttle walk test.…”

“…Climbing two flights of stairs corresponds to a V9O 2 max of ,12 mL?kg ?min -1 in those who are able to climb five flights of stairs [78]. Therefore, limiting the minimum number of flights that should be climbed might be most useful for large-scale screening of patients of all ages undergoing high-risk surgery [80,[84][85][86].…”

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

“…After thoracic surgery, a poor functional capacity has been associated with an increased mortality (relative risk 18.7; 95% CI 5.9 -59); however, in comparison with thoracic surgery, a poor functional status was not associated with an increased mortality after other noncardiac surgery (relative risk 0.47; 95% CI 0.09-2.5). 38 This may reflect the importance of pulmonary function-strongly related to functional capacity-as a major predictor of survival after thoracic surgery. These findings were confirmed in a study of 5939 patients scheduled for non-cardiac surgery, in which the pre-operative functional capacity measured in METs showed a relatively weak association with post-operative cardiac events or death.…”

Preoperative cardiac risks in noncardiac surgery: The role of coronary angiography

“…Poor exercise tolerance, expressed by inability to climb two flights of stairs or run a short distance (<4 METs) predicts worse perioperative outcomes especially after thoracic surgery [5].…”