Prediction of morbidity after lung resection with risk factors using treadmill exercise test

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Abstract
Objective: To predict accurate morbidity after lung resection using treadmill exercise test. Methods: A total of 130 patients (108 men and 22 women, with mean age 67.1±11.4 years (range, 34–78 years)) of 1129 patients underwent standard lobectomy were performed both treadmill exercise test and spirometry preoperatively. We measured maximum oxygen uptake/body weight (VO2max/BW) and change in arterial blood oxygen pressure from rest to symptom-limited maximum loading (delta aPaO2) and calculated exercise-induced hypoxemia (delta PaO2/delta VO2/BW), and retrospectively compared these parameters for patients with and without complications. Results: There were five patients with severe postoperative complications, including three requiring use of a respirator, two with home oxygen therapy. %Vital capacity, VC (%, 80.2±13.2 vs. 92.5±20.9, P=0.026), delta PaO2 (Torr, −29.3±4.3 vs. −13.2±10.8, P=0.0004), VO2max/BW (ml/min/kg, 16.5±2.9 vs. 20.6±5.1, P=0.018) and delta PaO2/delta VO2/BW (Torr/ml/min/kg, −1.98±0.26 vs. −0.57±0.47) were significantly associated with worse outcome. All the five patients with complications had delta PaO2/delta VO2/BW<−1.7. Conclusions: Treadmill exercise testing is a good method for assessment of cardiopulmonary reserve. Limited resection must be performed if delta PaO2/delta VO2/BW is under −1.7.

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