Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients☆

Nuria Novoa 0 Gonzalo Varela 0 Marcelo F. Jimenez 0 Jose Luis Aranda 0 0 Thoracic Surgery Service, University Hospital of Salamanca , Spain To describe and compare the daily ambulatory activity of the patients before and one month after major lung resection. Daily activity was measured using a pedometer (OMROM Walking Style PRO ) given preoperatively in a prospective way to a series of 21 consecutive cases scheduled for lobectomy or pneumonectomy. Analyzed variables were age, pulmonary function, mean number of total and aerobic steps per day, walked distance and mean daily time of aerobic activity. Activity variables were analyzed individually and as a new differential variable DELTA. Wilcoxon and Mann-Whitney nonparametric tests were used for comparison between groups. General series data: 19 male. Age: 63"10.9 years. FEV1%: 88.4"22.7. DLCO: 86.2"21.6. Eleven cases had COPD criteria. Type of surgery: 3 pneumonectomyy18 lobectomy. Activity data: all patients showed a global decrease of their activity one month after surgery but, patients in the pneumonectomy group are unable to keep aerobic activity meanwhile patients that undergone lobectomy showed only a 25% reduction in the measured variables. Major pulmonary resection decreases the time and the quality of the daily ambulatory activity of the patients during the first postoperative month. Despite limitations, the chosen pedometer OMRON Walking Style Pro is an efficient tool to evaluate the perioperative daily ambulatory activity of patients. 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved. 1. Introduction In the majority of patients, functional respiratory parameters suffer a postoperative impairment after lung resection and remain decreased up to three months after surgery w1x. On the contrary, patients have a more early and complete recovery of their exercise tolerance, measured as peak VO2 w2x. Thus, traditional parameters used to assess the postoperative cardio-respiratory function seem not to correlate with the postoperative exercise capacity. On the other hand, lung resection determines a transient worsening of quality of life (QOL) at one month following the operation with most of the scales returning to preoperative values at three months, except after pneumonectomy w35x, and it has been shown that functional assessment of respiratory capacity and exercise tests do not correlate with the QOL reported by the patients w3x. We have hypothesized that daily activity measured by means of a pedometer could be a good correlate of postoperative QOL. To our knowledge, there are no published papers measuring daily exercise capacity of the patients after lung resection. In COPD patients, moderate relationships have been observed between clinical characteristics Presented at the 17th European Conference on General Thoracic Surgery, Krakow, Poland, May 31June 3, 2009. *Corresponding author. Thoracic Surgery Service, Paseo de San Vicente 5284, 37007 Salamanca, Spain. Tel./fax: q34 923 291 383. E-mail address: (N. Novoa). 2009 Published by European Association for Cardio-Thoracic Surgery and physical activity and only GOLD stages III and IV correctly predicted very inactive patients w6x. We have conducted a cross-sectional study to measure daily activity in a series of patients before and after lung resection as a first step to investigate the correlation between postoperative daily exercise capacity and QOL. 2. Methods 2.1. Studied population This is a prospective study performed on 21 consecutive patients referred to our unit for lobectomy (18 cases) or pneumonectomy (3 cases) due to non-small cell lung cancer. Patients that had preoperative chemo- or radiotherapy were excluded. All patients signed their informed consent to participate in the study, which was approved by the local IRB. The selection criteria for operation were the same all over the recruitment period and consisted of: Karnofski index over 50%, a predicted postoperatory forced expiratory volume in percentage (FEV1ppo) of over 30%, absence of hypercarbia and no concomitant bad prognostic systemic disease. Patients scheduled for chest wall or diaphragm resections also were excluded. All cases were operated through a muscle-sparing mini-thoracotomy and a lobe-specific or systematic nodal dissection was also performed. Postoperative data acquisition continued a mean of 30 days and stopped before any adjuvant treatment was started. N. Novoa et al. / Interactive CardioVascular and Thoracic Surgery 9 (2009) 934938 2.2. Measuring daily activity Activity was measured by means of an OMROM Walking Style Pro pedometer. This model is capable of differentiating between activity producing an increment of the cardiac rate up to 85% of the maximal adjusted by age (called aerobic) and other type of movement. After 10 min of continuous walking 60 steps per minute, the aerobic mode is activated and it gets deactivated after 1 min break. Capacity of the pedometer memory assured 41 days of complete activity store. Data acquisition was performed by downloading pedometer records on a computer using the specific software. At the initial consultation, patients were instructed on how to use the pedometer and it was adjusted for weight and stride length of each patient. Data were downloaded at admission for surgery and the patients were asked to wear the pedometer again at discharge and to return to outpatient clinic 30 days after discharge. 2.3. Variables and data analysis The recorded variables were the following: a) For typifying the group of selected patients: age, sex, body mass index (BMI), preoperative FEV1%, preoperative carbon monoxide diffusing capacity (DLCO) and presence or absence of chronic obstructive pulmonary disease (COPD) according to the standard Gold criteria. b) From the pedometer: preoperative mean daily total steps (named as PreTotals), preoperative mean daily aerobic steps (PreAerobs), mean preoperative time of aerobic activity measured in minutes (PreAtime) and mean daily walked distance measured in km in the preoperative period (PreDis). The same variables were recorded during the postoperative period named as PosTotals, PostAerobs, PostAtime and PostDis. c) A new variable (DELTA) was created to measure the variation between pre- and postoperative values. The new variable was calculated as follows: DELTAs(postoperative variable presurgery variable)y presurgery variable=100 For data analysis and comparison, Wilcoxon and Mann Whitney non-parametric tests were used. 3. Results Twenty-one patients agreed to participate and were included in the study. Nineteen were males and 18 underwent lobectomy. General characteristics of the patients are as follows expressed as mean"S.D.: age: 63"10.9 (range: 4885); BMI: 24.6"4.1 (range 17.132.5); FEV1(%): 88.45"22.7 (range: 47.2131.7); FVC(%): 98.5"23.2 (range 56.3137) and DLCO: 86.2"21.6 (range: 47118). COPD was present in 11 patients. Cardiac morbidity consi (...truncated)