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Open Access

The role of the Shuttle Walking Test in predicting mortality and morbidity post oesophagogastric surgery

  • P Whiting1,
  • P Murray1,
  • S Hutchinson1,
  • C Stoddard1 and
  • R Ackroyd1
Critical Care20059(Suppl 1):P43

https://doi.org/10.1186/cc3106

Published: 7 March 2005

Keywords

Critical CareMaximal Oxygen UptakeAnaerobic ThresholdPreoperative TestClinical Requirement

Introduction

The Shuttle Walking Test (SWT) has been previously shown to correlate well with patients' maximal oxygen uptake (VO2 max) [13]. Older and colleagues demonstrated that an anaerobic threshold of 911 ml/min/kg, in patients undergoing major abdominal surgery, was an excellent predictor of mortality from cardio-respiratory causes [4]. Patients undergoing oesophagogastric surgery currently have a 30-day mortality of approximately 9% in our institution and are all admitted to critical care postoperatively. Our aim was to assess the value of a preoperative SWT in trying to identify high-risk patients.

Method

All patients listed for oesophagogastrectomy between April 2002 and September 2004 undertook a SWT as a standard part of their preoperative assessment. Routine anaesthesia, surgery and critical care was provided guided by clinical requirements. Thirty-day mortality was compared retrospectively with shuttle test data.

Results

Thirty-nine patients undertook a SWT, and had surgery. The mean age of the group was 64 years (range 44–81 years). The mean SWT distance was 480 m (range 220–880 m). At the 30th postoperative day, 18 patients had been discharged home (46.2%), 14 patients remained on the wards (35.9%), three still required critical care (7.7%) and four patients had died (10.2%). No patient with a SWT of greater than 350 m died within 30 days of surgery. Patients with a SWT of 350 m and below had a 50% 30-day mortality.

Discussion

This small patient group appears to be representative of the oesophagogastric surgical population within our institution (mortality 10.2% vs 9%). A SWT of 350 m appears to be a sensitive marker of increased postoperative mortality in this particular patient population. This finding is consistent with Lewis and colleagues' [2] data correlating SWT distance with VO2 max and Older and colleagues' [4] work on the anaerobic threshold and perioperative outcome. Further evaluation is required, but using this simple, cheap and reliable non-invasive preoperative test may help to risk-stratify patients undergoing high-risk surgery. High-risk groups may benefit from appropriately informed consent for surgery but potentially also from preoperative cardiopulmonary training and a focused utilisation of resources.

Authors’ Affiliations

(1)
Sheffield Teaching Hospitals, Sheffield, UK

References

  1. Morales FJ, et al.: Am Heart J. 1999, 138: 291-298.PubMedView ArticleGoogle Scholar
  2. Lewis ME, et al.: Heart. 2001, 86: 183-187. 10.1136/heart.86.2.183PubMedPubMed CentralView ArticleGoogle Scholar
  3. Singh SJ, et al.: Eur Resp J. 1994, 7: 2014-2020.Google Scholar
  4. Older P, et al.: Chest. 1999, 116: 355-362. 10.1378/chest.116.2.355PubMedView ArticleGoogle Scholar

Copyright

© BioMed Central Ltd 2005

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