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Using the 6-minute walk test to predict disability-free survival after major surgery

2018; Elsevier BV; Volume: 122; Issue: 1 Linguagem: Inglês

10.1016/j.bja.2018.08.016

1471-6771

Mark Shulman, Brian H. Cuthbertson, Duminda N. Wijeysundera, Rupert M. Pearse, Bruce Thompson, Elizabeth Torres, A. Ambosta, Sophie Wallace, Paddy Farrington, Paul S. Myles, Sophie Wallace, Bruce Thompson, Mathew J. Ellis, B. Borg, Ross Kerridge, J. Douglas, John D. Brannan, Jeffrey J. Pretto, M.G. Godsall, N. Beauchamp, Sandra L. Allen, A. Kennedy, E. Wright, J. Malherbe, Hilmy Ismail, Bernhard Riedel, Andrew Melville, H. Sivakumar, A. Murmane, K. Kenchington, Usha Gurunathan, C. Stonell, K. Brunello, Katherine T. Steele, Oystein Tronstad, P. Masel, Annette Dent, Emma Smith, A Bodger, M. Abolfathi, P Sivalingam, Adrian Hall, Thomas Painter, S. Macklin, Adrian D. Elliott, Anna María Claverol Carrera, N Terblanche, S. Pitt, Jason M. Samuels, C. Wilde, Andrew MacCormick, Kate Leslie, David E. Bramley, Anne Marie Southcott, Jonathan Grant, H. Taylor, Samantha Bates, Miriam Towns, Anna Tippett, Fiona Marshall, Colin J. L. McCartney, Stephen Choi, Priya Somascanthan, K. Flores, W. Scott Beattie, Keyvan Karkouti, Hance Clarke, Angela Jerath, Stuart A. McCluskey, Marcin Wąsowicz, Paul Oh, Lauren Day, Janneth Pazmino‐Canizares, K. Hagen, Douglas Campbell, Timothy G. Short, J. Van Der Westhuizen, Kushlin Higgie, Helen Lindsay, R. Jang, Chris Ho Ming Wong, Davina McAllister, M Ali, Jonathan Kumar, Ellen Waymouth, C. Kim, J. Dimech, Michael Lorimer, Joyce Tai, R. Miller, Rachel Sara, A. Collingwood, Sue Olliff, S. Gabriel, Helen Houston, Paul Dalley, Sally Hurford, Anna Hunt, Lynn Andrews, Leanlove Navarra, A. Jason-Smith, Bruce Thompson, N. McMillan, G. Back, Magda Melo, Muhammad Mamdani, Graham S. Hillis, Harindra C. Wijeysundera,

Hemodynamic Monitoring and Therapy

BackgroundThe 6-min walk test (6MWT) is a common means of functional assessment. Its relationship to disability-free survival (DFS) is uncertain.MethodsThis sub-study of the Measurement of Exercise Tolerance for Surgery study had co-primary outcome measures: correlation of the preoperative 6MWT distance with 30 day quality of recovery (15-item quality of recovery) and 12 month WHO Disability Assessment Schedule scores. The prognostic utility of the 6MWT and other risk assessment tools for 12 month DFS was assessed with logistic regression and receiver-operating-characteristic-curve analysis.ResultsOf 574 patients recruited, 567 (99%) completed the 6MWT. Twelve months after surgery, 16 (2.9%) patients had died and 444 (77%) had DFS. The 6MWT correlated weakly with 30 day 15-item quality of recovery (ρ=0.14; P=0.001) and 12 month WHO Disability Assessment Schedule (ρ=–0.23; P<0.0005) scores. When the cohort was split into 6MWT distance tertiles, the adjusted odds ratio of low vs high tertiles for DFS was 3.13 [95% confidence interval (CI): 1.54–6.35]. The only independent variable predictive of DFS was the Duke Activity Status Index (DASI) score (adjusted odds ratio: 1.06; P<0.0005). The area under the receiver-operating-characteristic curve for DFS was 0.63 (95% CI: 0.57–0.70) for the 6MWT, 0.60 (95% CI: 0.53–0.67) for cardiopulmonary-exercise-testing-derived peak oxygen consumption, and 0.70 (95% CI: 0.64–0.76) for the DASI score.ConclusionsOf the risk assessment tools analysed, the DASI was the most predictive of DFS. The 6MWT was safe and comparable with cardiopulmonary exercise testing for all predictive assessments. Future research should aim to determine the optimal 6MWT distance thresholds for risk prediction.