Does the incremental shuttle walk test predict the development of a hospital acquired pneumonia in patients undergoing elective oesophagectomy: A service evaluation

Abstract

Introduction Post-operative morbidity following oesophagectomy is high, with pulmonary complications, including hospital acquired pneumonia (HAP), the most commonly reported. Functional assessment to determine fitness for surgery is important to provide an individualised risk profile, helping to guide collaborative decision making around selection for surgery and post-operative care. The incremental shuttle walk test (ISWT) can be used to objectively measure functional capacity. Previous studies have demonstrated walking <350m on the ISWT is associated with significantly higher 30 day and 3-year mortality. The aim of this service evaluation was to assess if walking <350m on the ISWT correlated with the development of HAP. Methods Consecutive patients with oesophagogastric cancer listed for an elective oesophagectomy at a large U.K. tertiary hospital between December 2017 and February 2020 were included in analysis. All patients completed the ISWT at pre assessment clinic approximately 1 week prior to surgery. Primary outcome was incidence of HAP. Secondary outcomes included re-intubation rates, intensive care unit (ICU) re-admissions, ICU and hospital length of stay, and 30, 90 day and 12 month mortality. Results 121 patients completed the ISWT and were included in analysis of which 25 (21%) walked <350m. Those walking <350m had significantly higher rates of hospital acquired pneumonia (44% v. 11%, p = 0.0003) and spent significantly longer on ICU (5 v. 3 days, p = 0.041). Poor performance on ISWT had no significant effect on either 30, 90 day or 12 month mortality. Conclusion Walking less than 350 metres on the ISWT pre operatively was associated with a significant increase in the likelihood of developing HAP and longer stays in the ICU. The ISWT may therefore be a useful tool to help manage patient and clinician expectations, guide clinical decision making related to post-operative care, for example, high dependency unit vs ICU and direct post-operative resources like physiotherapy to patients most at risk.