Preoperative Hand Grip Strength and Outcomes

From January 1^st, 2007 to December 31^th, 2008, there were 68 patients included in the study. This is a prospective study. The study was approved by the institution review board of Mackay Memorial Hospital. 7 patients were excluded due to loss of follow-up, could not adequately perform the tests due to stroke or due to incomplete data, Patients with other cancer history were also excluded. There were 61 patients have complete records for analysis. Patients were tested at least 3 times several days prior to operation. Low hand-grip strength here was defined as grip strength lower than 25 kg in the dominant hand. Other laboratory data, history of other co-morbidities and risk factors were also recorded for risk analysis. The standard position for testing hand-grip strength is standing position with upper limb relaxed down to the sides of the body and palm towards the torso. The elbow is extended without any flexion. The handedness is also recorded for comparison. Co-morbidities included diabetes, poor renal function, hypertension, ischemic heart disease, liver cirrhosis or other disease considered to have great influence on patients' outcome. Complications included postoperative acute respiratory failure, anastomotic leakage, wound infection, early esophageal stricture requiring endoscopic dilatation, and pleural effusion requiring tube drainage. Surgical mortality was defined as either patients died within 30 days after operation or in-hospital death without discharge. Mortality was defined to any patients died less than 6 months after operation during follow-up. Pathology stage was based on resected specimens. Early stage was defined as patients having stage 1 and stage 2. Advanced stage was defined as patients having stage 3 and 4. All patients included were followed for at least 6 months in the outpatient department.
SPSS (version 13.0) was used to help analyze the correlation of each risk factors with morbidity, mortality and hospital stay. Chi square test, Student t-test and Pearson correlation test were used to compare the influences of each factor. Receiver operating curve analysis was used to determine the most appropriate cut-off value of the tests. Regression analysis was used to evaluate the influence of each factor on outcome.