S. R. Goraya1, N. M. Barnett1, K. Arivoli1, H. Nielsen1, N. J. Graham1, A. C. Chang2, M. A. Corriere3 1University Of Michigan, Medical School, Ann Arbor, MI, USA 2University Of Michigan, Thoracic Surgery, Ann Arbor, MI, USA 3University Of Michigan, Vascular Surgery, Ann Arbor, MI, USA
Introduction:
Grip strength is a simple and efficient screening test that can predict survival, perioperative adverse events, and non-home discharge following elective operations. Limited population-specific evidence exists, however, regarding its utility for risk assessment among patients being evaluated for thoracic surgery. We hypothesized that grip strength is useful for risk assessment among patients with lung or esophageal cancer and evaluated associations with survival.
Methods:
Adult patients with a diagnosis of lung or esophageal cancer who underwent grip strength measurement during outpatient thoracic surgery clinic visits were identified retrospectively. Dominant hand grip strength was measured using a calibrated hydraulic hand dynamometer. Categorical weakness was defined as grip strength <20th percentile of a community-dwelling population, adjusted for sex and body mass index (BMI). A Kaplan Meier survival analysis was done for categorical weakness, and Log-rank test was used to assess for a difference in the survival curves. Associations between grip strength/categorical weakness and survival were evaluated using Cox Proportional Hazards models, adjusted for BMI, age, sex and cancer diagnosis.
Results:
137 patients with lung (n=117) or esophageal (n=20) cancer who underwent grip strength measurement were identified and analyzed. 56/137 (41%) were female and 122/137 (89%) were Caucasian. Mean age was 71.4 years (SD: 8.3). Overall prevalence of categorical weakness was 51/137 (37%). Mortality was 39/137 (28%) over a median follow-up of 30.4 months (IQR: 3.1) after grip strength measurement. Univariate Kaplan Meier analysis indicated a significant difference in survival between weak and non-weak patients (p=0.011). A multivariable model adjusted for age, sex, BMI, surgical intervention during follow-up, and cancer diagnosis indicated that each 1 kg increase in grip strength was associated with increased survival (HR:0.91, 95%CI: 0.84-0.98, p=0.011). Conversely, categorical weakness was associated with decreased survival (HR:2.09, 95%CI: 1.04-4.19, p=0.036) in a model adjusted for age, surgical intervention during follow-up, and cancer diagnosis.
Conclusion:
Preoperative categorical weakness as defined by grip strength is associated with decreased survival for patients with lung or esophageal cancers under consideration for surgical intervention. Patient-selection for surgical candidacy and clinical decision making may be guided by these metrics.
