F. Boujibar1, A. Gillibert2, T. Bonnevie3, P. Rinieri4, J. Selim1, F.E. Gravier3, J.-M. Baste1
1Rouen University Hospital, Thoracic Surgery, Rouen, France, 2Rouen University Hospital, Biostatistic Unit, Rouen, France, 3Adir Association, Bois Guillaume, France, 4Clinique du Cèdre, Bois Guillaume, France
Background: Lung resection 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 condition and cardiorespiratory capacity to determine the risk of postoperative complications. The reference standard for stratification of surgical risk is currently the cardiopulmonary exercise test (CPET).
However, CPET is largely underused, for several reasons, as accessibility. As an alternative to CPET, some low-technology tests as the 6-minute stepper test (6MST) and the sit-to-stand test (STST) have been described.
These low-technology tests allow for functional assessment, reproducing movements of daily life, but their ability to predict complications following major lung surgery has not been evaluated.
However, CPET is largely underused, for several reasons, as accessibility. As an alternative to CPET, some low-technology tests as the 6-minute stepper test (6MST) and the sit-to-stand test (STST) have been described.
These low-technology tests allow for functional assessment, reproducing movements of daily life, but their ability to predict complications following major lung surgery has not been evaluated.
Purpose: The objective of this study was to assess whether the 6MST and the STST could be used in the preoperative evaluation of patients undergoing major lung resection to predict postoperative morbidity following surgery.
Methods: This prospective inception cohort study was conducted in the Department of Thoracic Surgery, Rouen University Hospital, France. Consecutive adults planned for major lung resection with minimally invasive surgery were recruited between November 2018 and November 2019. Patients had a preoperative functional evaluation with the 6MST and STST. The participants’ results on the two preoperative exercise tests were analysed for their ability to predict postoperative complications.Complications of grade ≥ 2 on the Clavien- Dindo classification were recorded for 90 days following surgery.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed to report this study.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed to report this study.
Results: 118 patients with a mean age of 65 years (SD 9) were included and analyzed. To predict a postoperative complication of grade ≥ 2 on the Clavien-Dindo classification, the area under the Receiver Operating Characteristic curve was: 0.82 (95% CI 0.75 to 0.90) for the number of steps during the 6MST, with an optimum cut-off of 140 steps; and 0.85 (95% CI 0.77 to 0.93) for the number of lifts during the STST, with an optimum cut-off of 20 lifts.
Conclusions: The 6MST and STST are useful tools to assess candidates for major lung resection. These tests could help to stratify the risk of postoperative morbidity. The STST is easier to use than the 6MST in practice and has a similar prognostic value. A patient achieving, 20 lifts or less during the STST or, 140 steps or less during the 6MST is a patient at risk of postoperative complications.
Implications: Before surgery, as well as postoperatively, the role of the physiotherapist is both to evaluate, rehabilitate, and detect possible disorders.
The 6MST and STST are cheap, widely reproducible and require minimal personnel and equipment; they are easily achievable during the preoperative consultation to determine operability.
The physiotherapist may identify patients at risk of complications and determine the prehabilitation program. Along with the surgeon and anesthesiologist, the physiotherapist must prepare the patient, to be in optimal condition on the day of surgery and to benefit from simple care following surgery.
The 6MST and STST are cheap, widely reproducible and require minimal personnel and equipment; they are easily achievable during the preoperative consultation to determine operability.
The physiotherapist may identify patients at risk of complications and determine the prehabilitation program. Along with the surgeon and anesthesiologist, the physiotherapist must prepare the patient, to be in optimal condition on the day of surgery and to benefit from simple care following surgery.
Funding acknowledgements: Rouen University Hospital
Keywords:
Lung resection
Low-technology tests
Prehabilitation
Lung resection
Low-technology tests
Prehabilitation
Topics:
Cardiorespiratory
Disability & rehabilitation
Oncology, HIV & palliative care
Cardiorespiratory
Disability & rehabilitation
Oncology, HIV & palliative care
Did this work require ethics approval? Yes
Institution: The French research ethics committee
Committee: CPP Ile de France X
Ethics number: ID RCB: 2018-A02694-51
All authors, affiliations and abstracts have been published as submitted.
