Two flights up, a powerful predictor of post-op peril

Stair-climbing ability reliably foretells after-surgery risk among people with pulmonary hypertension, a study shows.

People with pulmonary hypertension – high blood pressure in the vessels that carry blood to the lungs – have higher risks for complications after any surgery. Because pulmonary hypertension is growing in the United States, due to our aging populace and pervasive unhealthy pursuits, anesthesiologists are looking for ways to risk-stratify these patients when they’re scheduled to go under the knife for a nose job, gallbladder removal, rotator-cuff repair or something else. 

It turns out, among this patient population, that one question is a quite good predictor of postoperative complications: Can you walk up two flights of stairs without stopping for shortness of breath?

The findings are published today in PLOS ONEIn the study, researchers reviewed 550 non-cardiac, non-obstetric procedures performed on patients with pulmonary hypertension. Their impetus was to see if there’s a simpler way to detect risk than echocardiography, the conventional screening, said co-author Gail Van Norman, a UW Medicine anesthesiologist.

“Asking a person a question is a pretty inexpensive test that yields an immediate answer, compared with echocardiography, a standard screen used to detect that level of risk, which costs more than $3,000 and which needs to be scheduled,” she said.

“Say you’re an anesthesiologist in Coeur d’Alene and a patient who you know with severe pulmonary hypertension is supposed to undergo a laparoscopic gallbladder removal. Are they at such high risk that you should refer them to a large medical center? If they can walk up two flights of stairs, you probably can do that case and reassure them that their risks of complications are pretty low.”

If the stair-climbing answer is “no,” that helps anesthesiologists to decide about further preoperative testing and to ensure that all precautionary measures are in place for that patient’s surgery.

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