S17 Cardio-respiratory exercise, incremental shuttle walk test and thoracoscore in predicting outcomes following thoracotomy

Background Current treatment guidelines for lung cancer patients undergoing thoracotomy suggest using a Cardio-Pulmonary Exercise Test (CPET) Incremental Shuttle Walk Test (ISWT) and Thoracoscore as part of the pre-operative assessment to determine operability and post-operative morbidity for curative lung cancer treatment (NICE, 2019)(ERS, 2011). Consequently, the risk stratification pathway for lung cancer patients undergoing thoracotomy is extensive and has become a burden for both patients and respiratory departments throughout the UK. This study was designed to explore the potential utility of each of the measurements for risk stratification of thoracotomy. Aims To explore which exercise tests best quantifies the risk of surgery in patients undergoing thoracotomy at Manchester University Hospital and to identify any correlation with Length of Hospital Stay (LOHS), unplanned intensive care admissions and the re-admission rate at 90 days. Methods The study adopted a consecutive recruitment technique. Fifteen lung cancer patients performed CPET and ISWT prior to thoracotomy surgery; thoracoscore was calculated. Results No statistical difference was identified between patients who experienced complications and those who didnrt (p>0.05). Mean VO2 peak: 17.02 ml.min.kg (SD 2.8 ml.min.kg) in those with complications; 14.03 ml.min.kg (SD 3.2 ml.min.kg) in those without. As with ISWT distance (p>0.05): mean Distance walked 263.2 m (SD 70 m) in those with complications; 308.9 m (SD 126 m) in those without. However, LOHS was correlated with SpO2 desaturation (r = 0.857, n=15 p-value=0.00). The readmission rate at 90 days was 11%. Conclusion No statistically significant relationships between pre-operative variables such as VO2Peak (ml/min), VO2 Peak (ml/min/kg), VE/VCO2, Workload, Distance walked, Thoracoscore, SpO2 desaturation and the post-operative outcomes were identified. A positive correlation between SpO2 desaturation and LOHS was found; the smaller the desaturation, the shorter the hospital stay.The results of the study disagree with the recommendations made by national guidelines for radical treatment of thoracotomy (NICE, 2019) (BTS, 2001) (ERS, 2011). Therefore, it is uncertain if pre-operative exercise assessments are useful for predicting post-operative outcomes. Nevertheless, the study provided a foundation to warrant further research in this patient cohort.