In a groundbreaking study published in BMC Cancer, researchers have revealed compelling evidence that a decline in physical endurance, as measured by the 6-minute walk test (6MWT) after pulmonary resection surgery, significantly increases the risk of hospital readmission. This retrospective cohort study, examining the postoperative outcomes of lung surgery patients, highlights an important prognostic indicator that may transform postoperative care and patient monitoring in thoracic surgery.
Pulmonary resection is a common surgical intervention primarily performed to treat lung cancer and other serious pulmonary conditions. Despite advances in surgical techniques and postoperative care, complications such as hospital readmission remain a challenge, affecting patient quality of life and healthcare resource utilization. Identifying reliable predictors for adverse postoperative outcomes has therefore become a focal point in improving patient prognosis and healthcare strategies.
The 6-minute walk test, a widely accepted measure of functional capacity, involves assessing the distance a patient can walk on a flat, hard surface in six minutes. It is a simple yet powerful tool reflecting cardiopulmonary and muscular endurance. In this study, a cohort of 99 patients undergoing pulmonary resection between 2015 and 2018 was evaluated for changes in 6MWT distance before and after surgery, to investigate the relationship between decreased physical performance and hospital readmission risk.
Subjects were stratified into two groups based on the degree of decline in their 6MWT distance following surgery. The “decreased group” experienced a reduction of 30 meters or more, while the “unchanged group” had less than a 30-meter decline. The distinction was essential to observe how varying degrees of postoperative functional loss influenced clinical outcomes, particularly hospital readmission rates and mortality.
Significantly, the study found that the decreased group, comprising 53 patients, had notably higher rates of hospital readmission compared to the unchanged group of 46 patients. Specifically, the decreased group saw 14 readmissions, whereas the unchanged group recorded only five. Statistical analysis confirmed that this disparity was significant, with a p-value of 0.04, indicating a strong association between reduced walk distance and readmission risk.
Although overall survival between the two groups did not differ markedly, the data suggested a trend towards lower survival in patients with decreased 6MWT distances, indicated by a borderline p-value of 0.07. This nuanced finding underscores the clinical relevance of functional decline post-surgery, not only as a marker for short-term complications but possibly affecting longer-term survival outcomes as well.
To delve deeper into risk stratification, the researchers employed a Cox proportional hazards model, which affirmed that a greater than 30-meter decrease in 6MWT distance independently predicted hospital readmission. The hazard ratio calculated was 3.05 with a 95% confidence interval ranging from 1.02 to 9.15, solidifying the magnitude of risk associated with postoperative functional decline.
Importantly, the study noted that other clinicopathologic factors, such as patient demographics and disease characteristics, did not significantly differ between groups except for operative time, suggesting that the observed differences in outcomes were closely linked to physical capacity changes rather than baseline patient conditions.
The implications of these findings are profound. Surgeons and clinicians could implement pre- and post-surgery 6MWT assessments as part of routine care to identify patients at elevated risk for complications. Early identification would enable tailored interventions, such as enhanced pulmonary rehabilitation, closer follow-up, or preemptive support services, aimed at reducing readmission rates and improving recovery trajectories.
Furthermore, the 6-minute walk test’s non-invasive, cost-effective nature renders it an accessible option for clinics worldwide, even in resource-limited settings. Standardizing its use could foster better comparative research across institutions and contribute to developing guidelines for postoperative care in thoracic surgery.
This research also sheds light on the potential pathophysiological mechanisms underlying postoperative decline. Pulmonary resection often results in reduced lung volume and compromised respiratory efficiency, which might contribute directly to diminished exercise tolerance. The deconditioning that follows surgery, coupled with possible complications like infections or cardiac stress, can exacerbate functional decline and justify increased surveillance in vulnerable patients.
Though the study was retrospective and limited to a single center with a relatively small sample, its findings pave the way for larger, prospective investigations. Future studies could assess whether targeted rehabilitation interventions can mitigate the loss of 6MWT distance and ultimately reduce readmission frequency, improving both patient outcomes and healthcare system burdens.
Moreover, exploring the interplay between 6MWT changes and biomarkers of inflammation or cardiopulmonary function could enrich understanding and refine risk models. Such integrative approaches may pinpoint patients who would benefit most from aggressive postoperative management strategies.
Given the rising incidence of lung cancer globally and the increasing utilization of pulmonary resection, optimizing postoperative care remains a public health priority. This study’s revelation that a straightforward physical performance metric can predict readmission risk offers a tangible tool to clinicians aiming to enhance patient care pathways.
In conclusion, the demonstrated association between decreased 6-minute walk distance post-pulmonary resection and increased hospital readmission represents an important advancement in perioperative medicine. It underscores the critical role of functional assessment in tailoring treatment and surveillance plans, potentially transforming standard clinical practice and ultimately improving patient quality of life.
Subject of Research: Postoperative prognosis and hospital readmission risk linked to changes in 6-minute walk distance after pulmonary resection.
Article Title: Decreased 6-minute walk distance after pulmonary resection increases the risk of postoperative hospital re-admission: a retrospective cohort study
Article References:
Maniwa, H., Naito, M., Ono, M. et al. Decreased 6-minute walk distance after pulmonary resection increases the risk of postoperative hospital re-admission: a retrospective cohort study. BMC Cancer 25, 1397 (2025). https://doi.org/10.1186/s12885-025-14821-6
Image Credits: Scienmag.com
