Timed Stair Climbing Is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

Abstract

Background Current methods to predict patients' peri-operative morbidity utilize complex algorithms with multiple clinical variables focusing primarily on organ-specific compromise. The aim of the present study is to determine the value of a timed stair climb (SC) in predicting peri-operative complications for patients undergoing abdominal surgery. Study Design From March 2014 to July 2015, 362 patients attempted SC while being timed prior to undergoing elective abdominal surgery. Vital signs were measured before and after SC. Ninety day post-operative complications were assessed by the Accordion Severity Grading System. The prognostic value of SC was compared to the ACS NSQIP risk calculator. Results A total of 264 (97.4%) patients were able to complete SC. SC time directly correlated to changes in both mean arterial pressure and heart rate as an indicator of stress. An Accordion grade 2 or higher complication occurred in 84 (25%) patients. There were 8 mortalities (2.4%). Patients with slower SC times had an increased complication rate (P<0.0001). In multivariable analysis SC time was the single strongest predictor of complications (OR=1.029, P<0.0001), and no other clinical co-morbidity reached statistical significance. Receiver operative characteristic curves predicting post-operative morbidity by SC time was superior to that of the ACS risk calculator (AUC 0.81 vs. 0.62, P<0.0001). Additionally slower patients had a greater deviation from predicted length of hospital stay (P=0.034) Conclusions SC provides measurable stress, accurately predicts post-operative complications, and is easy to administer in patients undergoing abdominal surgery. Larger patient populations with a diverse group of operations will be needed to further validate the use of SC in risk prediction models.

Establishing a proactive geriatrician led comprehensive geriatric assessment in older emergency surgery patients: Outcomes of a pilot study

“…Frailty is typically associated with independent risk factors for morbidity and mortality, including malnutrition, limited functional ability, preoperative dependency and multiple falls. Both these latter factors are associated with an additional increased risk to postoperative institutionalisation . Appropriate management of comorbidities can also improve postoperative outcomes; for example, hepatic cirrhosis, congestive cardiac failure and arrhythmia are associated with 30‐day mortality rates of 8.9%, 8.2% and 5.7% respectively…”

Cancer‐driven changes link T cell frequency to muscle strength in people with cancer: a pilot study

“…The SCP is a measure of lower extremity balance, strength, and power. Elevated stair climb time correlates with elevated heart rate and slower recovery in people recovering from surgery . Also, HGS and stair climb time (SCT) have been used as primary outcome measures in phases II–III clinical trials for anabolic agents in development for the treatment of cancer‐induced cachexia …”

The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction

“…For example, simplified clinical review (e.g., the Surgical Risk Preoperative Assessment System), timed stair-climbing, and frailty assessment have been suggested as alternative methods of risk prediction. 9,10,37,38 Performance of these other models within cancer patient populations has not been rigorously assessed to date, and the findings here suggest these alternative measures may be equally problematic to predict the inherent excessive variability of cancer surgery outcomes. Many of these risk models advocate for the immediate use of these models at the bedside through incorporation into electronic health record platforms.…”

“…Early efforts focused on procedure- or specialty-specific perioperative risk, 7,8 but standardization and simplification of risk models have been more characteristic of the recent trend. 9,10 Within the last decade, the American College of Surgeons’ (ACS) National Surgical Quality Improvement Program (NSQIP) and its associated all-procedure risk calculator have set the standard in terms of both scale and ease of use. 8,11 Risk prediction models have been assessed in cancer-only populations, and it has been shown that these models do not perform as well in a highly specific cancer surgery contexts often lacking complete information on cancer type, stage, etc.…”