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Ann Thorac Surg 2007;84:197-202
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Influence of Preoperative Exercise Capacity on Length of Stay After Thoracic Cancer Surgery

^a Department of Medicine, Division of Cardiology, Memorial Sloan-Kettering Cancer Center, New York, New York
^b Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York

Accepted for publication February 2, 2007.

^_* Address correspondence to Dr Weinstein, Department of Medicine, Division of Cardiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (Email: weinsteh{at}mskcc.org).

Presented at the Poster Session of the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

Background: Stress testing is frequently used to assess cardiac risk before thoracic surgery. However, the relationship between treadmill exercise capacity and length of stay (LOS) has not been investigated. We hypothesized that exercise capacity, a strong predictor of long-term prognosis, can also predict LOS after thoracic cancer surgery.

Methods: Accordingly, 191 consecutive patients who had exercise stress testing before major thoracic cancer surgery were retrospectively grouped by poor (<4 metabolic equivalents [METs], n = 31), fair (4 to 7 METs, n = 107), good (7 to 10 METs, n = 30), and excellent (>10 METs, n = 23) exercise capacity. The relationship between exercise capacity and LOS was then determined.

Results: Average LOS was inversely related to exercise capacity, with a nearly twofold increase in LOS between the excellent and poor exercise groups (4.8 versus 9.2 days). This relationship remained significant even after controlling for operation type, history of dyspnea, sex, and smoking history in analysis of covariance. Prolonged hospital stay (10 days or more) was strongly predicted by exercise capacity. Failure to exceed 4 METs was associated with a high risk of prolonged stay (9 of 31, 39%), whereas none of the 23 patients who exceeded 10 METs had a prolonged stay.

Conclusions: Treadmill exercise capacity has independent predictive value for LOS and risk of prolonged stay after thoracic cancer surgery. These findings have important implications for risk assessment and cost, suggesting that preoperative programs designed to improve exercise capacity may favorably influence LOS and associated costs.

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Invited commentary

Douglas E. Paull
Ann. Thorac. Surg. 2007 84: 202. [Extract] [Full Text] [PDF]

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