Singh Anupama, Xie Yue, Mazzola Emanuele, Wang Sue, McAllister Miles, Pezeshkian Fatemehsadat, Cooper Lisa, Frain Laura N, Wilder Fatima G, Steimer Desiree, Jaklitsch Michael T, DuMontier Clark
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA.
Ann Surg Oncol. 2025 Jun;32(6):4181-4188. doi: 10.1245/s10434-025-17066-6. Epub 2025 Feb 27.
As a powerful, objective marker of frailty, 4-m gait speed (4MGS) can predict morbidity and mortality in various populations including cardiac surgery and oncology patients. Its role in thoracic surgery is understudied. This study aimed to evaluate associations between preoperative 4MGS and outcomes after pulmonary resection.
A cohort study analyzed patients undergoing pulmonary resections at a high-volume surgical center from January 2021 to October 2023. Preoperative 4MGS was prospectively collected by medical assistants as part of routine vital sign assessments in clinic. Uni- and multivariable analyses were performed to evaluate the associations of preoperative 4MGS with postoperative length of stay, adverse events, and discharge disposition, controlling for lung function (FEV1), extent of resection, comorbidity, and other covariates.
Overall, 401 patients were included (median age, 69 years; interquartile range, 61-75 years): 123 (31%) lobectomy and 278 (69%) sublobar resection patients. After controlling for covariates, each decrease of 0.1 m/s in 4MGS was associated with average longer length of stay (beta, 0.12; 95% confidence interval [CI], 0.01-0.23) and increased odds of adverse events (odds ratio [OR], 1.10; 95% CI 1.00-1.25). These associations were largely maintained when analyses were repeated within the lobar and sublobar cohorts. Among the sublobar resections, decreases in 0.1 m/s of 4MGS was associated with increased odds of discharge to home requiring home services or to a rehabilitation facility (OR, 1.10; 95% CI 1.00-1.22).
Preoperative 4MGS is independently associated with important surgical outcomes after lung resection. The 4MGS marker can complement other preoperative measures used to risk-stratify patients undergoing lung resection.
作为一种强大的、客观的衰弱标志物，4米步态速度（4MGS）可以预测包括心脏手术和肿瘤患者在内的各种人群的发病率和死亡率。其在胸外科手术中的作用尚未得到充分研究。本研究旨在评估术前4MGS与肺切除术后结局之间的关联。
一项队列研究分析了2021年1月至2023年10月在一家大型手术中心接受肺切除术的患者。术前4MGS由医疗助理作为门诊常规生命体征评估的一部分进行前瞻性收集。进行单变量和多变量分析，以评估术前4MGS与术后住院时间、不良事件和出院处置之间的关联，并控制肺功能（FEV1）、切除范围、合并症和其他协变量。
总体而言，纳入了401例患者（中位年龄69岁；四分位间距61 - 75岁）：123例（31%）肺叶切除术患者和278例（69%）肺段以下切除术患者。在控制协变量后，4MGS每降低0.1 m/s与平均住院时间延长相关（β，0.12；95%置信区间[CI]，0.01 - 0.23），且不良事件发生几率增加（优势比[OR]，1.10；95% CI 1.00 - 1.25）。当在肺叶和肺段以下切除队列中重复分析时，这些关联基本保持。在肺段以下切除术中，4MGS降低0.1 m/s与出院回家后需要家庭服务或转至康复机构的几率增加相关（OR，1.10；95% CI 1.00 - 1.22）。
术前4MGS与肺切除术后重要的手术结局独立相关。4MGS标志物可补充用于对肺切除患者进行风险分层的其他术前措施。
