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 Researchers asked 362 adult patients undergoing elective abdominal
surgeries to climb up and down a flight of stairs before the
operations and also measured how much their vital signs changed
after completing the exercise compared to when they were at rest.
When people were slower on the stairs, they were more likely to
experience spikes in blood pressure and heart rate, which may
indicate stress from the exertion, the study team reports in the
Journal of the American College of Surgeons.
The slowest patients were also most likely to have post-surgical
complications, a finding that suggests this simple climbing test
might be a good way for doctors to determine which people face the
biggest risks from undergoing operations, said lead study author Dr.
Sushanth Reddy of the University of Alabama at Birmingham.
"Our approach here was to come up with a simplified way to estimate
risk," Reddy said by email.
"This is a simple test that takes just a minute or so to do," Reddy
added. "The results can easily be explained to the patient and will
make the conversation regarding the potential complications that
much easier."
Among other things, one current formula surgeons use to assess
pre-surgical risk includes questions like how many drugs patients
take to manage hypertension, with the assumption that people who
need four medications might face worse potential outcomes than
patients who can keep blood pressure in check with just one pill,
Reddy said.
Another common risk-assessment tool looks at patients' overall
muscle strength, which can be accurate but cumbersome because it
requires an expert trained in analyzing muscle density on a CT scan,
Reddy pointed out.
To see if stair climbing ability could serve as an alternative tool
for predicting risk of post-surgical problems, Reddy and colleagues
asked people to walk up and down a flight of seven steps.
About 7 percent of them weren't up to the task.
For the remaining 338 patients who could get up and down the stairs,
their average time was 18 seconds.
Overall, 84 participants had at least one complication within 90
days after surgery, while another 258 people had none.
Many patients with complications were overweight or had high blood
pressure, diabetes or elevated cholesterol. The median age of people
with complications was 65 years, compared to 59 among those without
complications.
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But the only factor that was associated with a statistically
significant increase in the odds of complications was a slower speed
on the stairs.
On average the stair climbing test took about 23 seconds for people
who experienced complications after surgery, compared with 15
seconds for participants who didn't have problems after the
procedures.
This amounted to about 11 percent higher odds of post-operative
complications within 90 days after procedures for the people who
were slow on the stairs before they went under the knife.
One limitation of the study is that the standard calculator for
assessing post-surgical complications and deaths tends to follow
people for just 30 days, making it difficult to compare this method
to the alternative stair-climbing test that looked at 90-day
outcomes, the authors note. The longer time range, however, may be a
more accurate indicator of complications that can often crop up more
than a month after patients have operations, the authors also point
out.
"When people climb stairs, they have to use more cardiac function; a
longer timed stair climb test then suggests that patients have
poorer physiologic function," said Dr. Nita Ahuja of Johns Hopkins
University in Baltimore.
"The timed stair climb test is a metric of frailty and as the
population is getting older, it is important to identify frailty,"
Ahuja, who wasn't involved in the study, added by email. "The timed
stair test is an easy to perform test that can be done quickly and
doesn't require additional costs."
SOURCE: http://bit.ly/1Qhx0LG Journal of the American College of
Surgeons, online January 28, 2016.
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