Use of the six minute walk test to predict recovery and complications in morbidly obese patients undergoing elective surgery

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Wollongong Hospital is a large regional hospital that performs approximately 13 000 episodes of operative care per year. The range of surgery performed covers all areas apart from cardio-thoracic, including neurosurgery, vascular, orthopaedics, urology, ENT general, colo-rectal, endoscopy, imaging, obstetrics and gynaecology, general paediatrics, and plastic surgery. The anaesthesia department at Wollongong Hospital has an audit and research focus particularly in the fields of education, obesity, and geriatric care. Australian Bureau of Statistics data report that 62.8% of adult Australians were overweight or obese in 2011-12. Of this number, approximately 12% had a body mass index (BMI) greater than or equal to 35, which, in the presence of comorbidities, has been defined as morbid obesity. Local data show that at least 13% of patients undergoing elective surgery at Wollongong Hospital each year are morbidly obese. Most of the literature suggests that morbidly obese patients have higher rates of clinical complications in the post-operative period than the non-obese although this finding has not been universally reported. Assessment of risk in obese patients cannot accurately be based on the presence of obesity alone. Measurement of functional capacity pre-operatively is considered essential for useful risk stratification and prediction of post-operative outcomes. Cardiopulmonary exercise testing (CPET) is the gold standard for assessing cardio-respiratory fitness. However, CPET is expensive, resource-intensive, and requires a dedicated specialist laboratory and trained technicians. In contrast, the six minute walk test (6MWT) is a simple and cheap test for evaluation of cardio-respiratory function that has compared well to CPEX in previous studies. It may be ideal for assessing functional capacity in morbidly obese patients as it can be performed by existing staff in a pre-operative assessment area and has been shown to be safe for morbidly obese patients in multiple papers. There are currently no published data on the use of the 6MWT as a screening tool to predict high risk in obese patients undergoing surgery. The aim of this study is to assess the ability of the 6MWT to predict postoperative functional recovery and medical complications in morbidly obese patients in Wollongong Hospital who attend a pre-admission assessment clinic (PAC). Identification of this subset of patients would allow peri-operative teams to target further investigations, optimise surgical planning, and stratify the intensity of intra-operative and post-operative care. With these strategies, it may be possible to decrease morbidity and mortality and the associated healthcare costs to the community.

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