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Eur J Cardiothorac Surg 2005;27:1133
© 2005 Elsevier Science NL

Letter to the Editor

Does the shuttle walk test correlate with postoperative morbidity in lung surgery?

Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai 400012, India

Received 20 December 2004; accepted 18 February 2005.

^* Corresponding author. Tel.: +91 22 24177000; fax: +91 22 24146937. (E-mail: cspramesh{at}vsnl.net).

Key Words: Shuttle walk test • Lung surgery • Morbidity

We read with interest Win and colleagues' article [1] on the evaluation of shuttle walk testing and correlation with postoperative morbidity in lung surgery. We are puzzled as to why the authors attempted to compare the mean shuttle walk distance (SWD) between the ‘good outcome group’ with the ‘poor outcome group’. Such a comparison is both statistically and clinically irrelevant and puts the cart before the horse instead of the other way round. It would be more appropriate to attempt to identify a cutoff shuttle walk distance which could separate the ‘good outcome group’ from the ‘poor outcome group’. If they had identified a distance of say, 250m, and analysed the postoperative outcome to see whether it predicted morbidity, it would have made a useful contribution. In their own study, the poor outcomes were considerably more in patients with a SWD less than 250m (8/12 patients, 66%) compared to those with a SWD more than 250m (26/91 patients, 29%). With a cutoff of 300m, the difference in postoperative poor outcome would be 51% (18/35 patients) vs. 24% (16/68 patients). Though only a detailed analysis of the individual patient data would identify statistical significance in these values, it does seem to be a clinically significant difference. Most studies [2–4] have shown exercise testing to be a useful tool in identifying patients with poor postoperative outcome and the results of this study do not mandate a change from this view.

References

1. Win T, Jackson A, Groves AM, Wells FC, Ritchie AJ, Munday H, Laroche CM. Relationship of shuttle walk test and lung cancer outcome. Eur J Cardiothorac Surg 2004;26:1216-1219.[Abstract/Free Full Text]
2. Bolliger CT, Jordan P, Soler M, Stulz P, Gradel E, Skarvan K, Elsasser S, Gonon M, Wyser C, Tamm M. Exercise capacity as a predictor of postoperative complications in lung resection candidates. Am J Respir Crit Care Med 1995;151:1472-1480.[Abstract]
3. Matsuoka H, Nishio W, Sakamoto T, Harada H, Tsubota N. Prediction of morbidity after lung resection with risk factors using treadmill exercise test. Eur J Cardiothorac Surg 2004;26:480-482.[Abstract/Free Full Text]
4. Brunelli A, Monteverde M, Refai MA, Fianchini A. Stair climbing test as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly. Ann Thorac Surg 2004;77:266-270.[Abstract/Free Full Text]

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