Takei Kensuke, Konno Hayato, Katsumata Shinya, Maeda Koki, Kojima Hideaki, Isaka Mitsuhiro, Mori Keita, Ohde Yasuhisa
Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan.
Gen Thorac Cardiovasc Surg. 2025 Mar;73(3):171-179. doi: 10.1007/s11748-024-02059-1. Epub 2024 Jul 15.
The stair-climbing test (SCT) is used as a surrogate for cardiopulmonary exercise testing, which measures maximal oxygen uptake, and considered a useful method for assessing exercise capacity in thoracic surgery. This study aims to investigate whether the recovery time of percutaneous oxygen saturation (SpO) after stair climbing is a predictor of postoperative complications after lobectomy.
We retrospectively identified 54 patients who performed SCT and underwent lobectomy between January 2015 and February 2023 at Shizuoka Cancer Center. The SpO recovery time was defined as the time required to recover from the minimum to resting value after stair climbing. The association between SpO recovery time and early postoperative pulmonary complications within 30 days after surgery was analyzed.
Eleven patients (20.4%) had postoperative pulmonary complications (≥ Clavien-Dindo Classification Grade 2). The cutoff value of SpO recovery time obtained from the receiver operating characteristic curve analysis was 90 s [sensitivity, 81.8%; specificity, 72.1%; AUC, 0.77 (95% confidence interval, 0.64-0.90)]. The occurrence of postoperative pulmonary complications was 42.9% in the delayed recovery time (DRT; SpO recovery time ≥ 90 s) group and 6.1% in the non-DRT (SpO recovery time < 90 s) group (p = 0.002). DRT was a predictor of postoperative pulmonary complications (odds ratio, 11.60; 95% CI 2.19-61.80).
DRT of SpO after stair climbing is a predictor of postoperative pulmonary complications following lobectomy in borderline patients who require exercise capacity assessment. SpO monitoring after stair climbing may be useful as one of the preoperative assessments in patients undergoing lobectomy.
爬楼梯试验（SCT）被用作心肺运动试验的替代方法，后者可测量最大摄氧量，并且被认为是评估胸外科手术患者运动能力的一种有用方法。本研究旨在探讨爬楼梯后经皮血氧饱和度（SpO）的恢复时间是否可作为肺叶切除术后并发症的预测指标。
我们回顾性纳入了2015年1月至2023年2月期间在静冈癌症中心进行SCT并接受肺叶切除术的54例患者。SpO恢复时间定义为爬楼梯后从最低值恢复到静息值所需的时间。分析SpO恢复时间与术后30天内早期肺部并发症之间的关联。
11例患者（20.4%）发生了术后肺部并发症（≥Clavien-Dindo分级2级）。通过受试者工作特征曲线分析得出的SpO恢复时间的截断值为90秒[灵敏度，81.8%；特异性，72.1%；曲线下面积，0.77（95%置信区间，0.64-0.90）]。延迟恢复时间（DRT；SpO恢复时间≥90秒）组术后肺部并发症的发生率为42.9%，非DRT（SpO恢复时间<90秒）组为6.1%（p=0.002）。DRT是术后肺部并发症的预测指标（比值比，11.60；95%CI 2.19-61.80）。
爬楼梯后SpO的DRT是需要评估运动能力的临界患者肺叶切除术后肺部并发症的预测指标。爬楼梯后SpO监测可能作为肺叶切除患者术前评估的方法之一。
