Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery

Chest. 2001 Oct;120(4):1147-51. doi: 10.1378/chest.120.4.1147.


Study objective: Thoracotomy, sternotomy, and upper abdominal laparotomy are associated with high rate of postoperative cardiopulmonary complications (POCs). We hypothesized that symptom-limited stair climbing predicts POCs after high-risk surgery.

Design: A prospective evaluation of 83 patients undergoing thoracotomy, sternotomy, and upper abdominal laparotomy surgery.

Methods: The 52 men and 31 women completed symptom-limited stair climbing. A separate investigator, blinded to the number of flights of stairs climbed, assessed 30-day actual outcomes for POCs, including pneumonia, atelectasis, mechanical ventilation for > 48 h, reintubation, myocardial infarction, congestive heart failure, arrhythmia, pulmonary embolus, and death within 30 days of surgery. The operations performed included 31 lobectomies, 6 wedge resections, 3 pneumonectomies, 3 substernal thymectomies, 1 substernal thyroidectomy, 23 colectomies, 3 laparotomies, 7 abdominal aortic aneurysm repairs, 5 esophagogastrectomies, and 1 nephrectomy.

Results: POCs occurred in 21 of 83 patients (25%) overall, in 9 of 44 patients undergoing thoracotomy/sternotomy (20%), and in 12 of 39 patients undergoing upper abdominal laparotomy (31%). Of those unable to climb one flight of stairs, 89% developed a POC. No patient able to climb the maximum of seven flights of stairs had a POC. The inability to climb two flights of stairs was associated with a positive predictive value of 82% for the development of a POC. The number of days in the hospital postoperatively decreased with a patient's increased ability to climb stairs.

Conclusions: Symptom-limited stair climbing offers a simple, inexpensive means to predict POCs after high-risk surgery.

MeSH terms

  • Abdomen / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Exercise Test / methods*
  • Female
  • Heart Diseases / etiology*
  • Heart Diseases / mortality
  • Hospital Mortality
  • Humans
  • Lung Diseases / etiology*
  • Lung Diseases / mortality
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Pneumonectomy
  • Postoperative Complications / etiology*
  • Postoperative Complications / mortality
  • Predictive Value of Tests
  • Risk Assessment
  • Survival Analysis
  • Thoracotomy