Six-minute walk test as a predictor for intraoperative anesthesia complications: a prospective cohort at a tertiary hospital, southwestern Uganda

Abstract

Abstract Background The six-minute walk test (6MWT) is an indicator of a patient's overall cardiovascular and respiratory health. It is an inexpensive, and reproducible preoperative risk assessment tool that has been extensively employed to predict post-operative complications in various patient populations. There are limited data as to whether the 6MWT can predict intraoperative anesthesia complications. We determined the incidence of intraoperative complications and evaluated the association between the distance covered during the 6MWT and the incidence of intraoperative complications. Methods We conducted a prospective cohort study at Mbarara Regional Referral Hospital from January 17, 2023 to May 19, 2023, among patients who underwent elective surgeries. The intraoperative complications of interest were hypotension (≥ 20% reduction in mean arterial pressure [MAP]), hypertension (≥ 20% increase in MAP), bradycardia and hypoxia. Prior to surgery patients underwent a 6MWT; a distance ≤ 325 meters was considered short. Additional data were collected on patients’ sociodemographic, and medical characteristics using an interviewer-administered questionnaire. We performed log-binomial regression to determine the association between the distance covered during the 6MWT and incidence of intraoperative complications. Results We enrolled 169 participants with a median age of 41 years (IQR, 30–55 years); 123 (72.8%) were female. Of the 169 participants, 80 (47.3%) experienced hypotension, 66 (39.1%) experienced bradycardia, 58 (34.3%) experienced hypertension, 11 (6.6%) developed hypoxia, while 6 (3.6%) experienced post-extubation desaturation. The incidence of intraoperative complications was 1.4 times higher (adjusted risk ratio [aRR] = 1.44, 95%CI: 1.18–1.77, p < 0.001) among patients who walked ≤ 325 meters preoperatively than those who walked > 325 meters preoperatively. Conclusion The study identified hypotension and bradycardia as the predominant intraoperative complications, affecting over one-third of the participants. Importantly, a short six-minute walk distance independently predicted a higher incidence of intraoperative anesthesia complications. These findings underscore the potential value of routinely employing the 6MWT in preoperative assessments, particularly in low-resource settings, to identify patients at risk of intraoperative complications. Implementing this simple and cost-effective tool could lead to better patient outcomes and improved perioperative care.