Evaluating patients' walking capacity during hospitalization for lung cancer resection.

OBJECTIVES: The goal of this study was to describe non-supervised daily physical activity in patients during the period immediately following anatomical lung resection. METHODS: The study was an observational study on 50 consecutive patients (33 men) admitted for anatomical lung resection over a 4-month period. All cases were approached using a minimally invasive technique. Patients were instructed by nursing and physiotherapy staff and asked to wear a portable pedometer (Omron HJ-720 T-E2) from admission until hospital discharge, excluding the day of the operation and the first hours in the recovery room. The variables collected included sex, age, body mass index, type of lung resection, cardiopulmonary postoperative complications, percentage forced expiratory volume in 1 s, percentage single-breath carbon monoxide diffusing capacity, predicted postoperative forced expiratory volume in 1 s calculated according to functional segments removed at surgery, predicted postoperative single-breath carbon monoxide diffusing capacity calculated according to functional segments removed at surgery, total steps, aerobic steps and daily total strolled distance in metres. Comparison of activity was analysed using the paired t-test for individual data evolution and the unpaired t-test for patients showing complications or not. Body mass index and exercise capacity were analysed using the Spearman correlation analysis. RESULTS: A total of 34 patients underwent lobectomy or bilobectomy. All patients could walk on the first postoperative day. The average walked distance on the first and fourth postoperative days was 6100 m and 7400 m, respectively. Compared with the preoperative day, patients walked significantly fewer total steps on Day 1 and Day 2 (Day 1, P = 0.0001; Day 2, P = 0.049). The rate of aerobic to total daily steps was comparable after the second postoperative day. Patients having any postoperative cardiopulmonary complication showed a significantly inferior walking capacity (P < 0.001), both preoperatively and postoperatively, than their peers without complications. CONCLUSIONS: After anatomical lung resection, patients could perform a relevant amount of physical activity. These data could be useful for designing physical recovery programmes to be implemented postoperatively.

Results of a simple exercise test performed routinely to predict postoperative morbidity after anatomical lung resection.

BACKGROUND AND OBJECTIVE: Exercise tests are considered the most reliable ones for the preoperative workup of lung resection candidates but frequently are indicated only in cases with low predicted postoperative forced expiratory volume in 1s (FEV1) and carbon monoxide diffusing capacity (DLCO). The aim of this investigation is to evaluate if a simple, standardised incremental bicycle exercise test routinely performed in patients considered operable is predictive of postoperative cardio-respiratory complication and if its performance is comparable to a logistic regression model including frequently cited clinical predictive variables. METHODS: A series of 103 lung resection candidates were included in a prospective observational study. All patients underwent a standardised, incremental exercise test on a bicycle up to exhaustion. The analysed outcome was the occurrence of postoperative cardio-respiratory complications prospectively recorded and codified. The correlation of distance reached at the end of the test and the outcome was estimated by non-parametric tests. A logistic regression model including age, BMI, predicted postoperative (ppoFEV1%) and predicted postoperative DLCO (ppoDLCO) was adjusted and the individual probability of complication calculated and set as a new variable. Finally, two receiver operating characteristic (ROC) curves were constructed and compared: one with distance at the exercise test and the other with logistic regression probability of complication. RESULTS: Mortality of the series was nil. Outcome prevalence was 14%. Distance reached at the end of the exercise test was lower in cases with a positive outcome (3498.6m vs 4543.5m, p=0.001). On logistic regression analysis, age of the patient (p=0.016) and ppoDLCO (p=0.000) were predictive for the outcome. On ROC analysis, C-indices were 0.77 (distance) and 0.78 (logistic model, p=0.95). CONCLUSION: Reached distance in a simple standardised exercise test is related to postoperative morbidity after lung resection; and the accuracy of prediction using this variable alone is comparable to a logistic regression model including age and ppoDLCO.