Sk. Epstein et al., INABILITY TO PERFORM BICYCLE ERGOMETRY PREDICTS INCREASED MORBIDITY AND MORTALITY AFTER LUNG RESECTION, Chest, 107(2), 1995, pp. 311-316
The ability to successfully exercise has been used to assess the cardi
opulmonary risk of thoracotomy for lung cancer. Because of musculoskel
etal, neurologic, peripheral vascular, or behavioral problems, not all
patients presenting for pulmonary resection are capable of exercising
, Using a multifactorial cardiopulmonary risk index (CPRI) consisting
of a cardiac risk index (CRI) and a pulmonary risk index, we studied 7
4 patients (60 capable of exercising and 14 incapable of exercising) w
ho underwent thoracotomy for lung cancer resection. The groups were si
milar in reference to history of pulmonary disease, preoperative pulmo
nary function, and pulmonary risk index score. The no-exercise patient
s were more likely to have a history of cardiac disease (64 vs 28%; p
< 0.01) and had a higher CRI score (2.0 +/- 0.2 vs 1.4 +/- 0.1; p < 0.
05). Cardiopulmonary postoperative complications (POCs) and mortality
were more likely among those in the no-exercise group vs those in the
exercise group (POCs, 79 vs 35%, p < 0.01; mortality, 21 vs 2%, p < 0.
05). Among the eight no-exercise patients with a CPRI of 4 or more, al
l eight suffered a POC (100%) and three died (38%). Using multiple log
istic regression analysis, both the CPRI score and the inability to ex
ercise were independently associated with increased risk for POCs. We
conclude that patients unable to perform even minimal preoperative exe
rcise are at substantially increased risk for morbidity and mortality
after lung resection. This results both from greater identifiable preo
perative cardiopulmonary risk factors (as assessed by the CPRI) and fr
om an independent effect related to the inability to exercise.