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

ARTICLE IN PRESS doi:10.1510/icvts.2009.212332 Interactive CardioVascular and Thoracic Surgery 9 (2009) 934–938 www.icvts.org Work in progress report - Thoracic non-oncologic Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients夞 Nuria Novoa*, Gonzalo Varela, Marcelo F. Jiménez, Jose Luis Aranda Thoracic Surgery Service, University Hospital of Salamanca, Spain Abstract 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䊛 ) 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䊛 is an efficient tool to evaluate the perioperative daily ambulatory activity of patients. 䊚 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved. Keywords: Pedometer; Major lung resection; Daily ambulatory activity; Quality of life 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 w3–5x, 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 夞 Presented at the 17th European Conference on General Thoracic Surgery, Krakow, Poland, May 31–June 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). 䊚 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. Received 23 May 2009; received in revised form 30 July 2009; accepted 3 August 2009 ARTICLE IN PRESS N. Novoa et al. / Interactive CardioVascular and Thoracic Surgery 9 (2009) 934–938 3. Results PostAtime PreDis Postdis 61 72 85 1 1 1 80.7 89.3 65.1 4990.3 3904.7 5532.5 2354.8 1681.5 3439 2209.6 732.6 1986.3 203.7 0 229.8 21.8 8.75 21.5 2.16 0 2.71 3.28 2.8 3.92 1.54 1.2 2.40 49 49 50 57 57 71 72 75 78 48 53 53 57 63 64 64 70 75 1 1 2 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 99.5 121 115.1 91.25 101.3 111.7 131.7 73.2 108 81.4 47.2 102 63.8 103.5 68.7 58.2 78.7 66.1 10,080.4 11,851.5 10,961.2 8755.9 9847.8 8259.3 10,971.4 10,738.9 8537.9 13,967 9363.6 21,819 11,592.2 15,826.1 10,800.3 5849.7 4365.8 9070.7 7119.9 12,663.5 10,545 8735.7 8915 7188.7 12,548.3 4051.8 6294.3 12,021 1053 20,052.9 4358.1 7754 5229 8087.8 2862.4 4136 3031 3756 4678.8 431 6209.5 5270.1 2133.4 4031.1 3825 6295 1197.4 15,406 6425.6 12,401 122.9 62.3 1923.1 1853.9 1396 6566.8 5037 3798.7 3717.6 3527 4942.4 221.8 1966 3684.3 522.9 14,932.1 1639.1 5720.6 0 38.8 87.6 453.7 26.7 34.5 42.5 23.3 57 48.5 20 42 24.6 58.5 12.34 121.4 62 117.6 1.06 0.81 20.2 20 12.72 59.9 47 41.4 35.1 33.9 48.3 2.66 21 37 4.71 16.8 16.9 54.5 0 0.5 10 5.38 8.4 8.76 6.79 6.56 7.87 4.8 6.36 7.9 5.3 10.7 6.7 15.5 8.34 11.4 7.44 3.91 2.85 5.98 6.18 9.36 6.5 6.54 7.14 4.16 7.27 2.99 3.89 9.25 0.75 14.2 3.13 5.6 3.6 5.41 1.17 2.72 *Sex: value 1smale. Brief Case Report Communication PreAtime Historical Pages PostAerobs Nomenclature PreAerobs Best Evidence PosTotals State-of-the-art PreTotals Follow-up COPD FEV1% Negative Lobectomy No COPD Sex* Proposal for Bail- Pneumonectomy No COPD COPD Age ESCVS Table 1 Preoperative and postoperative individual data arranged by type of surgery and by presence or absence of COPD Institutional 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: 48–85); BMI: 24.6"4.1 (range 17.1–32.5); FEV1(%): 88.45"22.7 (range: 47.2–131.7); FVC(%): 98.5"2 (...truncated)