Stair-Climbing Tests or Self-Reported Functional Capacity for Preoperative Pulmonary Risk Assessment in Patients with Known or Suspected COPD-A Prospective Observational Study

André Dankert; Benedikt Neumann-Schirmbeck; Thorsten Dohrmann; Lili Plümer; Viktor Alexander Wünsch; Phillip Brenya Sasu; Susanne Sehner; Christian Zöllner; Martin Petzoldt

doi:10.3390/jcm12134180

Stair-Climbing Tests or Self-Reported Functional Capacity for Preoperative Pulmonary Risk Assessment in Patients with Known or Suspected COPD-A Prospective Observational Study

J Clin Med. 2023 Jun 21;12(13):4180. doi: 10.3390/jcm12134180.

Authors

André Dankert¹, Benedikt Neumann-Schirmbeck¹, Thorsten Dohrmann¹, Lili Plümer¹, Viktor Alexander Wünsch¹, Phillip Brenya Sasu¹, Susanne Sehner², Christian Zöllner¹, Martin Petzoldt¹

Affiliations

¹ Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
² Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.

Abstract

Background: This prospective study aims to determine whether preoperative stair-climbing tests (SCT) predict postoperative pulmonary complications (PPC) better than self-reported poor functional capacity (SR_PFC) in patients with known or suspected COPD.

Methods: A total of 320 patients undergoing scheduled for major non-cardiac surgery, 240 with verified COPD and 80 with GOLD key indicators but disproved COPD, underwent preoperative SR_PFC and SCT and were analyzed. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection. Two multivariable regression models were fitted, the SR_PFC model (baseline variables such as sociodemographic, surgical and procedural characteristics, medical preconditions, and GOLD key indicators plus SR_PFC) and the SCT model (baseline variables plus SCT_PFC).

Results: Within all stair-climbing variables, LASSO exclusively selected self-reported poor functional capacity. The cross-validated area under the receiver operating characteristic curve with bias-corrected bootstrapping 95% confidence interval (95% CI) did not differ between the SR_PFC and SCT models (0.71; 0.65-0.77 for both models). SR_PFC was an independent risk factor (adjusted odds ratio (OR) 5.45; 95% CI 1.04-28.60; p = 0.045 in the SR_PFC model) but SCT_PFC was not (adjusted OR 3.78; 95% CI 0.87-16.34; p = 0.075 in the SCT model).

Conclusions: Our findings indicate that preoperative SR_PFC adequately predicts PPC while additional preoperative SCTs are dispensable in patients with known or suspected COPD.

Keywords: chronic obstructive pulmonary disease; postoperative pulmonary complication; preoperative; pulmonary risk; self-reported poor functional capacity; stair-climbing test.

Grants and funding

We acknowledge financial support from the Open Access Publication Fund of UKE—Universitätsklinikum Hamburg-Eppendorf and DFG—German Research Foundation.