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. 2023 Jun 21;12(13):4180.
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

André Dankert  1 , Benedikt Neumann-Schirmbeck  1 , Thorsten Dohrmann  1 , Lili Plümer  1 , Viktor Alexander Wünsch  1 , Phillip Brenya Sasu  1 , Susanne Sehner  2 , Christian Zöllner  1 , Martin Petzoldt  1
Affiliations

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 et al. J Clin Med. .

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 (SRPFC) 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 SRPFC 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 SRPFC model (baseline variables such as sociodemographic, surgical and procedural characteristics, medical preconditions, and GOLD key indicators plus SRPFC) and the SCT model (baseline variables plus SCTPFC).

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 SRPFC and SCT models (0.71; 0.65-0.77 for both models). SRPFC was an independent risk factor (adjusted odds ratio (OR) 5.45; 95% CI 1.04-28.60; p = 0.045 in the SRPFC model) but SCTPFC 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 SRPFC 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.

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Conflict of interest statement

M.P. is a member of the Medical Advisory Board of Radiometer Medical, Copenhagen, Denmark. M.P. received a research grant awarded by Verathon Inc., Bothell, WA, USA. The other authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow. Abbreviations: CAT: chronic obstructive pulmonary disease assessment test; COPD: chronic obstructive pulmonary disease.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves and ten-fold cross-validated areas under the ROC curve (cvAUC) illustrate the discriminatory capability of two multivariable models to predict postoperative pulmonary complications in patients with known or suspected COPD undergoing major surgery. Abbreviations: bc-b 95% CI: bias-corrected bootstrapped 95% confidence interval; SRPFC: self-reported poor exercise capacity; SCT: stair-climbing test.
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