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Communications to the Editor |

Stair Climbing Test in Lung Resection Candidates With Low Predicted Postoperative FEV1 FREE TO VIEW

Alessandro Brunelli; Aroldo Fianchini
Author and Funding Information

“Umberto I°” Regional Hospital Ancona, Italy

Correspondence to: Alessandro Brunelli, MD, Via S. Margherita 23, Ancona 60129, Italy; e-mail: alexit_2000@yahoo.com



Chest. 2003;124(3):1179. doi:10.1378/chest.124.3.1179
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To the Editor:

We read with interest the article of Girish and colleagues (October 2001)1 on symptom-limited stair climbing test as an instrument to predict complications after thoracic and upper-abdominal surgery; however, we think the patients’ selection criteria used in their work are inappropriate and of little clinical use. The authors, in fact, excluded from lung resection those patients with a predicted postoperative FEV1 (ppoFEV1) < 40% of predicted.

During the last 3 years, we used maximal stair climbing test on 307 patients for risk stratification before lung resection.2 Fifteen of these patients had a ppoFEV1 < 40% of predicted. Nevertheless, they were submitted to lung resection (one segmentectomy, six lobectomies, eight pneumonectomies) for their good performance at the stair climbing test. Two patients climbed < 12 m, whereas the others climbed > 14 m, corresponding, in our setting, approximately to three and four flights of stairs, respectively. Preoperative maximal oxygen uptake (V̇o2max) did not differ between patients with a ppoFEV1 < 40% and those with a ppoFEV1 ≥ 40% (26 mL/kg/min vs 25.9 mL/kg/min, respectively; p = 0.9). Only three patients acquired postoperative cardiopulmonary complications with no mortality, and the morbidity rate was not different from that of the patients with a ppoFEV1 ≥ 40% (20% vs 17.5%, respectively; p = 0.8). All patients with a ppoFEV1 < 40% were able to perform a postoperative exercise test before discharge, which did not show a different V̇o2max with respect to the patients with a ppoFEV1 ≥ 40% (21.6 mL/kg/min vs 22.5 mL/kg/min, respectively; p = 0.4).

We think that the stair climbing test is most useful in assessing the cardiorespiratory capacity of those patients traditionally considered at prohibitive risk for lung resection in order to minimize their improper exclusion from operation. Using this test allowed us to operate on an additional 15 patients who would have otherwise been denied surgery. Based on our results, we think that the practice of excluding patients from operation only for their low predicted postoperative pulmonary function without performing a preoperative exercise test is questionable. We currently exclude from operation only those patients with a ppoFEV1 < 30% with an altitude climbed at the stair climbing test < 12 m.

Girish, M, Trayner, E, Damman, O, et al (2001) Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery.Chest120,1147-1151. [PubMed] [CrossRef]
 
Brunelli, A, Al Refai, M, Monteverde, M, et al Stair climbing test predicts cardiopulmonary complications after lung resection.Chest2002;121,1106-1110. [PubMed]
 

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References

Girish, M, Trayner, E, Damman, O, et al (2001) Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery.Chest120,1147-1151. [PubMed] [CrossRef]
 
Brunelli, A, Al Refai, M, Monteverde, M, et al Stair climbing test predicts cardiopulmonary complications after lung resection.Chest2002;121,1106-1110. [PubMed]
 
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