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Lark H1, Holden N1, Chapman O1, Weighill L1, George RS1
1University College Hospital, London, United Kingdom
Background: As techniques continue to advance, surgery is now offered to an increasing number of patients have significant co-morbidities. With the introduction of enhanced recovery programmes to standardise the approach to this increasingly complex population, there is a strong a focus on quality of life and patient experience throughout a patient's journey. Considering this, there is a growing role for physiotherapy in the provision of appropriate assessment tools to predict outcomes post-surgery. This also allows facilitation of realistic expectations following surgery. Cardiopulmonary exercise testing can be time consuming and costly. It can also be inappropriate to conduct in a significant proportion of patients with lung cancer due to their multiple co-morbidities. The incremental shuttle walk test (ISWT) has previously been validated to test underlying physiology and fitness for surgery. It is considered a more cost effective and time efficient tool that can be utilised in a greater proportion of our patient population.
Purpose: The primary objective of this trial is to assess the role of ISWT as a predictor of post-operative complications and length of stay (LOS) in patients undergoing lung resection surgery for cancer. The secondary objective is to investigate the relationship between ISWT and quality of life (QOL) using the 36-item Short Form Survey (SF36).
Methods: A prospective study is being conducted by physiotherapists following the approval of local ethical committee (18/WS/0013). Subsequent patients undergoing lung resection surgery for cancer were invited to complete the ISWT, a 10m shuttle test that is maximal and progressive. They also completed an SF36 questionnaire pre-operatively. Post-operative complications were recorded using the Melbourne Group Score (MGS). Patients completed a follow-up SF36 questionnaire 3 months post-operatively.
Results: Between 11/17 and 02/19, 90 patients (48% males, mean age 74.5 +/- 10.6 years) were recruited. The overall walked distance was 430 +/- 42 metres. The average level of exercise reached was 8+/- 0.4 with a significant rise in the heart rate by 22bpm (p 0.001). There was a significant negative correlation (p=0.012) between distance walked and overall post-operative MGS. The distance walked was a predictor of admission to HDU postoperatively (p 0.006). There was a significant correlation between distance walked and both pre-op physical and mental health composites of SF36 (p 0.01). 45 patients completed a follow up SF36 with no significant difference between pre- and post-operatively.
Conclusion(s): Current data shows that the ISWT is a useful tool to predict outcomes following lung resection surgery. The greater the pre-operative distance walked correlated to a subsequent reduction in post-operative complications and LOS. There was also correlation between ISWT and QOL. There was no significant change between pre- and postoperative SF36 scores suggesting patients did not experience negative effects on QOL as a result of having surgery.
Implications: This data indicates that physiotherapists can use the ISWT to assess increasingly complex patients to facilitate early recovery and discharge from hospital. There is also a significant link between fitness for surgery and QOL which enables physiotherapists to manage expectations throughout the patients' journey.
Keywords: Outcome Measurement, Surgery, Lung Cancer
Funding acknowledgements: Nil
Purpose: The primary objective of this trial is to assess the role of ISWT as a predictor of post-operative complications and length of stay (LOS) in patients undergoing lung resection surgery for cancer. The secondary objective is to investigate the relationship between ISWT and quality of life (QOL) using the 36-item Short Form Survey (SF36).
Methods: A prospective study is being conducted by physiotherapists following the approval of local ethical committee (18/WS/0013). Subsequent patients undergoing lung resection surgery for cancer were invited to complete the ISWT, a 10m shuttle test that is maximal and progressive. They also completed an SF36 questionnaire pre-operatively. Post-operative complications were recorded using the Melbourne Group Score (MGS). Patients completed a follow-up SF36 questionnaire 3 months post-operatively.
Results: Between 11/17 and 02/19, 90 patients (48% males, mean age 74.5 +/- 10.6 years) were recruited. The overall walked distance was 430 +/- 42 metres. The average level of exercise reached was 8+/- 0.4 with a significant rise in the heart rate by 22bpm (p 0.001). There was a significant negative correlation (p=0.012) between distance walked and overall post-operative MGS. The distance walked was a predictor of admission to HDU postoperatively (p 0.006). There was a significant correlation between distance walked and both pre-op physical and mental health composites of SF36 (p 0.01). 45 patients completed a follow up SF36 with no significant difference between pre- and post-operatively.
Conclusion(s): Current data shows that the ISWT is a useful tool to predict outcomes following lung resection surgery. The greater the pre-operative distance walked correlated to a subsequent reduction in post-operative complications and LOS. There was also correlation between ISWT and QOL. There was no significant change between pre- and postoperative SF36 scores suggesting patients did not experience negative effects on QOL as a result of having surgery.
Implications: This data indicates that physiotherapists can use the ISWT to assess increasingly complex patients to facilitate early recovery and discharge from hospital. There is also a significant link between fitness for surgery and QOL which enables physiotherapists to manage expectations throughout the patients' journey.
Keywords: Outcome Measurement, Surgery, Lung Cancer
Funding acknowledgements: Nil
Topic: Cardiorespiratory; Outcome measurement
Ethics approval required: Yes
Institution: University College London Hospital
Ethics committee: Local Ethics Committee
Ethics number: 18/WS/0013
All authors, affiliations and abstracts have been published as submitted.
