Reddy Sushanth, Contreras Carlo M, Singletary Brandon, Bradford T Miller, Waldrop Mary G, Mims Andrew H, Smedley W Andrew, Swords Jacob A, Wang Thomas N, Heslin Martin J
Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
J Am Coll Surg. 2016 Apr;222(4):559-66. doi: 10.1016/j.jamcollsurg.2016.01.010. Epub 2016 Jan 28.
Current methods to predict patients' perioperative morbidity use complex algorithms with multiple clinical variables focusing primarily on organ-specific compromise. The aim of the current study was to determine the value of a timed stair climb in predicting perioperative complications for patients undergoing abdominal surgery.
From March 2014 to July 2015, three hundred and sixty-two patients attempted stair climbing while being timed before undergoing elective abdominal surgery. Vital signs were measured before and after stair climb. Ninety-day postoperative complications were assessed by the Accordion Severity Grading System. The prognostic value of stair climb was compared with the American College of Surgeons NSQIP risk calculator.
A total of 264 (97.4%) patients were able to complete the stair climb. Stair climb time directly correlated to changes in both mean arterial pressure and heart rate as an indicator of stress. An Accordion grade 2 or higher complication occurred in 84 (25%) patients. There were 8 mortalities (2.4%). Patients with slower stair climb times had increased complication rates (p < 0.0001). In multivariable analysis, stair climb time was the single strongest predictor of complications (odds ratio = 1.029; p < 0.0001), and no other clinical comorbidity reached statistical significance. Receiver operative characteristic curves predicting postoperative morbidity by stair climb time was superior to that of the American College of Surgeons risk calculator (area under the curve = 0.81 vs 0.62; p < 0.0001). Additionally, slower patients had greater deviations from predicted length of hospital stay (p = 0.034).
Stair climb provides measurable stress, accurately predicts postoperative complications, and is easy to administer in patients undergoing abdominal surgery. Larger patient populations with a diverse group of operations will be needed to validate the use of stair climbing in risk-prediction models.
目前预测患者围手术期发病率的方法使用复杂算法，包含多个临床变量，主要关注器官特异性损害。本研究的目的是确定定时爬楼梯对预测接受腹部手术患者围手术期并发症的价值。
2014年3月至2015年7月，362例患者在接受择期腹部手术前进行定时爬楼梯测试。在爬楼梯前后测量生命体征。术后90天的并发症通过手风琴严重程度分级系统进行评估。将爬楼梯的预后价值与美国外科医师学会NSQIP风险计算器进行比较。
共有264例（97.4%）患者能够完成爬楼梯。爬楼梯时间与作为应激指标的平均动脉压和心率变化直接相关。84例（25%）患者发生手风琴2级或更高等级的并发症。有8例死亡（2.4%）。爬楼梯时间较慢的患者并发症发生率更高（p<0.0001）。在多变量分析中，爬楼梯时间是并发症的唯一最强预测因素（比值比=1.029；p<0.0001），其他临床合并症均未达到统计学意义。通过爬楼梯时间预测术后发病率的受试者工作特征曲线优于美国外科医师学会风险计算器（曲线下面积=0.81对0.62；p<0.0001）。此外，爬楼梯较慢的患者与预测住院时间的偏差更大（p=0.034）。
爬楼梯可提供可测量的应激，准确预测术后并发症，并且易于在接受腹部手术的患者中实施。需要更大规模、手术类型多样的患者群体来验证爬楼梯在风险预测模型中的应用。
