Comparison of 6-min Walk Test Distance Vs. Estimated Maximum Oxygen Consumption for Predicting Postoperative Pulmonary Complications in Patients Undergoing Upper Abdominal Surgery: a Prospective Cohort Study

Overview

Journal Perioper Med (Lond)

Publisher Biomed Central

Date 2023 May 24

PMID 37221581

Authors

Xin Yin

Jingwen Wang

Zhibo Xu

Fuyong Qian

Songbin Liu

Yuxi Cai

Zhaoshun Jiang

Xixue Zhang

Weidong Gu

Affiliations

Soon will be listed here.

Abstract

Objective: The present study aims to evaluate the predictive ability of estimated maximum oxygen consumption (e[Formula: see text]O) and 6-min walk distance (6MWD) for postoperative pulmonary complications (PPCs) in adult surgical patients undergoing major upper abdominal surgery.

Method: This study was conducted by collecting data prospectively from a single center. The two predictive variables in the study were defined as 6MWD and e[Formula: see text]O. Patients scheduled for elective major upper abdominal surgery from March 2019 to May 2021 were included. The 6MWD was measured for all patients before surgery. e[Formula: see text]O was calculated using the regression model of Burr, which uses 6MWD, age, gender, weight, and resting heart rate (HR) to predict aerobic fitness. The patients were categorized into PPC and non-PPC group. The sensitivity, specificity, and optimum cutoff values for 6MWD and e[Formula: see text]O were calculated to predict PPCs. The area under the receiver operating characteristic curve (AUC) of 6MWD or e[Formula: see text]O was constructed and compared using the Z test. The primary outcome measure was the AUC of 6MWD and e[Formula: see text]O in predicting PPCs. In addition, the net reclassification index (NRI) was calculated to assess ability of e[Formula: see text]O compared with 6MWT in predicting PPCs.

Results: A total of 308 patients were included 71/308 developed PPCs. Patients unable to complete the 6-min walk test (6MWT) due to contraindications or restrictions, or those taking beta-blockers, were excluded. The optimum cutoff point for 6MWD in predicting PPCs was 372.5 m with a sensitivity of 63.4% and specificity of 79.3%. The optimum cutoff point for e[Formula: see text]O was 30.8 ml/kg/min with a sensitivity of 91.6% and specificity of 79.3%. The AUC for 6MWD in predicting PPCs was 0.758 (95% confidence interval (CI): 0.694-0.822), and the AUC for e[Formula: see text]O was 0.912 (95%CI: 0.875-0.949). A significantly increased AUC was observed in e[Formula: see text]O compared to 6MWD in predicting PPCs (P < 0.001, Z = 4.713). And compared with 6MWT, the NRI of e[Formula: see text]O was 0.272 (95%CI: 0.130, 0.406).

Conclusion: The results suggested that e[Formula: see text]O calculated from the 6MWT is a better predictor of PPCs than 6MWD in patients undergoing upper abdominal surgery and can be used as a tool to screen patients at risk of PPCs.

References

Holland A, Spruit M, Troosters T, Puhan M, Pepin V, Saey D . An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014; 44(6):1428-46. DOI: 10.1183/09031936.00150314. View

Faulkner J, Gerhard J, Stoner L, Lambrick D . Self-Paced Walking within a Diverse Topographical Environment Elicits an Appropriate Training Stimulus for Cardiac Rehabilitation Patients. Rehabil Res Pract. 2012; 2012:140871. PMC: 3400393. DOI: 10.1155/2012/140871. View

. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166(1):111-7. DOI: 10.1164/ajrccm.166.1.at1102. View

Barakat H, Shahin Y, McCollum P, Chetter I . Prediction of organ-specific complications following abdominal aortic aneurysm repair using cardiopulmonary exercise testing. Anaesthesia. 2015; 70(6):679-85. DOI: 10.1111/anae.12986. View

Lee J, Chaloner E, Hollingsworth S . The role of cardiopulmonary fitness and its genetic influences on surgical outcomes. Br J Surg. 2005; 93(2):147-57. DOI: 10.1002/bjs.5197. View

Sitlinger A, Deal M, Garcia E, Thompson D, Stewart T, Macdonald G . Physiological Fitness and the Pathophysiology of Chronic Lymphocytic Leukemia (CLL). Cells. 2021; 10(5). PMC: 8151485. DOI: 10.3390/cells10051165. View

Deka P, Pozehl B, Pathak D, Williams M, Norman J, Alonso W . Predicting maximal oxygen uptake from the 6 min walk test in patients with heart failure. ESC Heart Fail. 2020; 8(1):47-54. PMC: 7835615. DOI: 10.1002/ehf2.13167. View

Hulzebos E, Helders P, Favie N, de Bie R, de la Riviere A, van Meeteren N . Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. 2006; 296(15):1851-7. DOI: 10.1001/jama.296.15.1851. View

McAlister F, Bertsch K, Man J, Bradley J, Jacka M . Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med. 2004; 171(5):514-7. DOI: 10.1164/rccm.200408-1069OC. View

10.

Moran J, Wilson F, Guinan E, McCormick P, Hussey J, Moriarty J . The preoperative use of field tests of exercise tolerance to predict postoperative outcome in intra-abdominal surgery: a systematic review. J Clin Anesth. 2016; 35:446-455. DOI: 10.1016/j.jclinane.2016.09.019. View

11.

Ramos R, Ladha K, Cuthbertson B, Shulman M, Myles P, Wijeysundera D . Association of six-minute walk test distance with postoperative complications in non-cardiac surgery: a secondary analysis of a multicentre prospective cohort study. Can J Anaesth. 2021; 68(4):514-529. PMC: 7932965. DOI: 10.1007/s12630-020-01909-9. View

12.

Du H, Wonggom P, Tongpeth J, Clark R . Six-Minute Walk Test for Assessing Physical Functional Capacity in Chronic Heart Failure. Curr Heart Fail Rep. 2017; 14(3):158-166. DOI: 10.1007/s11897-017-0330-3. View

13.

Hammal F, Quaife T, Purich K, Haennel R, Gragasin F, San Martin-Feeney D . Assessing the accuracy of algorithm-derived cardiorespiratory fitness in surgical patients: a prospective cohort study. Can J Anaesth. 2017; 64(4):361-369. DOI: 10.1007/s12630-017-0812-5. View

14.

Serejo L, Pereira da Silva-Junior F, Bastos J, de Bruin G, Mota R, de Bruin P . Risk factors for pulmonary complications after emergency abdominal surgery. Respir Med. 2006; 101(4):808-13. DOI: 10.1016/j.rmed.2006.07.015. View

15.

Burr J, Bredin S, Faktor M, Warburton D . The 6-minute walk test as a predictor of objectively measured aerobic fitness in healthy working-aged adults. Phys Sportsmed. 2011; 39(2):133-9. DOI: 10.3810/psm.2011.05.1904. View

16.

Win T, Jackson A, Sharples L, Groves A, Wells F, Ritchie A . Cardiopulmonary exercise tests and lung cancer surgical outcome. Chest. 2005; 127(4):1159-65. DOI: 10.1378/chest.127.4.1159. View

17.

Albouaini K, Egred M, Alahmar A, Wright D . Cardiopulmonary exercise testing and its application. Heart. 2007; 93(10):1285-92. PMC: 2000933. DOI: 10.1136/hrt.2007.121558. View

18.

Miskovic A, Lumb A . Postoperative pulmonary complications. Br J Anaesth. 2017; 118(3):317-334. DOI: 10.1093/bja/aex002. View

19.

Lee H, Kim H, Kang D, Kong S, Lee J, Lee G . Prognostic Value of 6-Min Walk Test to Predict Postoperative Cardiopulmonary Complications in Patients With Non-small Cell Lung Cancer. Chest. 2020; 157(6):1665-1673. DOI: 10.1016/j.chest.2019.12.039. View

20.

Nijbroek S, Schultz M, Hemmes S . Prediction of postoperative pulmonary complications. Curr Opin Anaesthesiol. 2019; 32(3):443-451. DOI: 10.1097/ACO.0000000000000730. View