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

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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 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. intraoperative anesthesia complications 6-minute walk test 6-minute walk distance Figures Figure 1 Figure 2 Introduction Intraoperative anesthesia complications significantly contribute to perioperative morbidity and mortality, making them crucial performance indicators for surgical theaters( 1 ). These complications encompass single or multiple occurences of hypotension, bradycardia, hypertension, hypoxia, or post-extubation desaturation during the intraoperative period. Various studies have documented their incidences as follows: hypotension at 48.8% ( 2 ), hypertension at 61.4%( 3 ), bradycardia at 35% ( 4 ), hypoxia at 6.8%( 5 ), and post-extubation desaturation at 4.3% ( 6 ). Preoperative assessment plays a crucial role in identifying high-risk patients for optimal intraoperative care ( 7 – 9 ). Individualized care and prior optimization based on these assessments have been associated with improved patient outcomes ( 10 ). While widely used in medical practice, tools like the simplified acute physiological score or acute physiological and chronic health evaluation score have not been extensively applied in surgical settings ( 11 ). These have faced challenges in low-income setting due to battery of investigations and higher skill set that may be required to interpret the results, limiting their applicability. The 6-minute walk test (6MWT) is a cost-effective, easily reproducible, and validated tool for predicting postoperative complications, as supported by various studies ( 12 – 16 ). Notably, a distance threshold of ≤ 325 meters has been shown to be indicative of increased risk for postoperative respiratory complications ( 17 ). These findings suggest the potential significance of the 6MWT in preoperative risk stratification and warrant further exploration of its utility in surgical settings. However, no previous study, to the best of our knowledge, has explored this specific association of the 6MWT in the context of intraoperative complications. In Uganda, anesthetists currently rely on the American Society of Anesthesiologists (ASA) physical status classification to stratify patients, but this approach has inherent challenges as it is subjective and may not consider all relevant factors, such as the patient's vitals, medical history, and medication history ( 18 ). Consequently, providing individualized care based solely on this classification can be inadequate, leading to potential predisposition of patients to intraoperative anesthesia complications. Moreover, the incomplete filling of anesthesia forms presents an additional challenge, resulting in the failure to accurately estimate the incidences of intraoperative complications. To address these gaps, we determined the incidence of intraoperative anesthesia complications and evaluated the association between the 6MWT and incidence intraoperative anesthesia complications among patients undergoing elective surgeries at Mbarara Regional Referral Hospital in southwestern Uganda. Methods Study design and setting This was a prospective cohort study, conducted at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda from January 17, 2023 to May 19, 2023. MRRH is located approximately 290 kilometers (180 miles) southwest of Kampala, Uganda's capital city. The hospital serves as the referral center for several districts in Uganda, including Mbarara, Isingiro, Bushenyi, Ntungamo, Kiruhura, and Ibanda, and has a catchment population of approximately four million people. The surgical theater records approximately 50 elective cases each month. Although perioperative assessments involve systematic clinical examinations, there is no routine utilization of risk stratification tools to assess patients for intraoperative or postoperative complications. The ASA classification is the only tool occasionally employed in this regard. Study population Participants were adult patients undergoing non-neurological elective surgery recruited from various wards, such as surgery and gynecology wards of MRRH. We included patients aged 18 years or older who were scheduled for elective surgery and had a Glasgow Coma Scale score of 15. Patients who refused to provide consent, those with orthopedic conditions affecting walking ability, persons listed on the theater schedule but not operated on, and those who had experienced and received treatment for myocardial infarction within the past three months were excluded from the study. Sample size estimation and sampling To determine the required sample size, we estimated a population size of 305 elective surgeries performed over a 6-month period, as obtained from the theater records. Since no incidence data for a similar population was available, we assumed a hypothesized percentage frequency of the outcome factor at 50% with a margin of error of ± 5%. Utilizing a confidence level of 95%, a design effect of 1, and the single proportion formula for sample size calculation, we calculated a sample size of 169 participants. The sample size calculation was performed using OpenEpi, Version 3, an open-source calculator. For the study sampling, we used consecutive sampling, in which every subject who met the inclusion criteria until the required sample size of 169 participants was achieved. Data collection and study procedures Upon release of the theater lists from various departments, research assistants actively searched for eligible patients on different wards, including surgery and gynecology. Informed consent was obtained from participants in their native language, Runyankole, or English, by research assistants proficient in both languages. The research assistants, who were medical doctors, also provided detailed explanations of the study procedure, benefits, contraindications, and the 6MWT before enrolling participants. Patient demographics, including age, sex, occupation, and location, were recorded following consent. Medical histories were collected, encompassing conditions like heart failure, hypertension, as well as behavioral practices such as smoking and alcohol consumption. Resting blood pressure, oxygen saturation, and pulse rate readings were taken. Patients were classified based on the ASA physical status classification, and their medical histories were documented. They were instructed to wear comfortable clothing and footwear, rest for at least 15 minutes, and undergo routine clinical procedures for measuring blood pressure, heart rate, and oxygen saturation. The six-minute walk test was conducted in several stages, involving area setup, standardized instructions to all patients, and continuous monitoring throughout the exercise. Patients were encouraged to cover the greatest distance within six minutes, along a point-to-point distance of 30 meters, with a chair placed at one end. The environment was maintained at a comfortable ambient temperature and humidity. Essential equipment, such as a stopwatch, pulse oximeter, emergency tools, and a clipboard with a pen for recording findings, were in place. Standardized instructions and encouragement were provided to patients, emphasizing walking without running or jogging. Patients were allowed to rest as needed, and time was recorded without stopping the stopwatch. Encouragement was given based on elapsed time, such as "You're doing great, five minutes to go" at one-minute mark, and "You are doing great, one minute to go" at five minutes. Upon completing the exercise, oxygen saturation, pulse rate, and modified dyspnea scale readings were recorded. Reasons for resting during the exercise were noted, and if oxygen saturation was above 85%, encouragement was provided every 15 seconds after resting. During the intraoperative period, patients' blood pressure, oxygen saturation, and pulse rate were documented from their anesthetic chart tables and added to their follow-up documents as part of the study. Additional data, such as the lowest and highest blood pressure, lowest saturation, and occurrences of desaturation, hypotension, or hypertension at extubation, were captured. Operational definitions The criteria for defining specific intraoperative complications were as follows: hypotension was characterized by a 20% reduction in mean arterial pressure from baseline ( 19 ), hypertension was identified as a 20% increase in mean arterial blood pressure, hypoxia was indicated by a saturation level below 95% ( 20 ); bradycardia was defined as a pulse rate less than 60 beats per minute( 21 ), and desaturation after extubation was identified as a saturation level below 90% for > 10 seconds( 6 ). A short six-minute walk distance was defined as a distance of 325 meters or less, as established in a previous study( 17 ). Data management and statistical analysis An Excel data tool was used to collect the data, and the data were later exported to STATA version 15 (StataCorp, College Station, Texas, USA) for analysis. We first described the characteristics of the study participants, categorical demographic and clinical variables using frequencies and percentages. We compared the participants’ characteristics between those who walked > 325 meters and those who walked ≤ 325 meters using Chi square test or Fischer’s exact test. Variables that exhibited a significant distribution difference (p < 0.05), those with biological plausibility (e.g., sex and ASA classification), were subsequently adjusted for in the multivariable log-binomial regression analysis, to determine the association between the six-minute walk distance (main exposure variable), and the occurrence of intraoperative complications. The associations were quantified as adjusted risk ratios (aRRs) accompanied by their respective 95% confidence intervals (CIs). Results The total number of 188 elective surgery cases were enrolled in the study. Of these, 19 were excluded because they were not operated; 169 patients were followed-up and discharged from the cohort after the intraoperative period (Fig. 1 ) Characteristics of study participants Of the 169 participants, 48 (28%) covered a distance of ≤ 325 meters during the 6MWT, while 121 participants (72%) covered a distance of > 325 meters. Regarding age, participants aged ≤ 40 years accounted for 49.1% of the total cohort, with 16.7% of them having a short 6MWT distance. In contrast, participants above 40 years old constituted 50.9% of the cohort, of which 83.3% had a short 6MWT distance (p < 0.001). The median age of the participants was 41 years (inter-quartile range [IQR]: 30–55 years) with more females (72.8%) than males (27.2%). Most of the patients had attained primary level education (46.8%); the majority had an ASA classification of one (90.5%). Most participants predominately resided in the rural areas (72%) and mostly received spinal anesthesia (77.5%) during their elective surgeries (Table 1 ). All the characteristics did not show any significant differences between the two groups, except for age. Table 1 Characteristics of study participants, by six-minute walk distance covered preoperatively Total cohort (N = 169), Six-minute walk (meters) Characteristic n (%) ≤ 325 (n = 48), n = 28 (%) > 325 (n = 121), n = 72(%) P value Age* (years) 40 86 (50.9) 40 (83.3) 46 (38.0) Sex 0.683 Male 46 (27.2) 12 (25.0) 34 (28.1) Female 123 (72.8) 36 (75.0) 37 (71.9) Level of education 0.193 None 24 (14.2) 11 (22.9) 13 (10.7) Primary 79 (46.8) 20 (41.7) 59 (48.8) Secondary 49 (29.0) 14 (29.2) 35 (28.9) Tertiary 17 (10.0) 3 (6.2) 13 (11.6) ASA class 0.062 1 153 (90.5) 40 (83.3) 113 (93.4) 2 15 (8.9) 7 (14.6) 8 (6.6) 3 1 (0.6) 1 (2.1) 0 (0.0) Type of anesthesia 0.223 Spinal 131 (77.5) 35 (72.9) 96 (79.3) General 1 (0.6) 1 (2.1) 0 (0.0) Spinal & general 37 (21.9) 12 (25.0) 25 (20.7) Type of surgery 0.203 Gynecological 102 (60.4) 30 (62.5) 72 (59.5) General 55 (32.5) 16 (33.3) 39 (32.2) ENT 1 (0.6) 1 (2.1) 0 (0.0) Urology 11 (6.5) 1 (2.1) 10 (8.3) Residence 0.258 Urban 47 (28.0) 9 (19.1) 38 (31.4) Rural 121 (72.0) 80 (80.9) 83 (68.6) History of smoking 25 (14.9) 10 (20.8) 15 (12.5) 0.229 History of alcohol consumption 46 (27.2) 10 (20.8) 36 (29.8) 0.240 History of chronic illnesses** 47 (27.8) 18 (37.5) 29 (24.0) 0.180 History of allergies 21 (12.5) 5 (10.6) 16 (13.2) 0.649 Resting heart rate (beats per minute) 0.902 100 37 (21.9 11 (22.9) 26 (21.5) Postural hypotension 34 (20.1) 13 (27.1) 21 (17.4) 0.155 * Median age = 41 years (IQR, 30–55 years); ENT : Ear Nose and Throat; ASA : American Society of Anesthesiologists physical status classification; ** Chronic illnesses include HIV (n = 14), peptic ulcer disease (n = 12), hypertension (n = 8), diabetes (n = 5) Intraoperative anesthesia complications Among 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 (Fig. 2 ). Among the 58 participants with hypertension as a complication, the majority (n = 49; 84.5%) were observed after an episode of hypotension. Association between the 6-minute walk test and intraoperative anesthesia complications After controlling for age, sex, and ASA class, the six-minute walk distance was an independent predictor for intraoperative complications. Participants who walked shorter distance (≤ 325 meters) had 1.4 times (aRR = 1.44, 95% CI: 1.18–1.77, p < 0.001) higher risk of experiencing intraoperative anesthesia complications compared to those who walked longer distance (Table 2 ). Table 2 Association between six-minute walk distance and intraoperative anesthesia complications among patients undergoing elective surgeries at Mbarara Regional Referral Hospital, Uganda, January–May 2023 Intraoperative Complications Unadjusted analysis Adjusted analysis Characteristic Yes (n = 116), n (%) No (n = 53), n (%) cRR (95% CI) p-value aRR (95% CI) P value 6MWTD (meters) ≤ 325 73 (62.9) 48 (90.6) 1.48 (1.25–1.77) < 0.001 1.44 (1.18–1.77) 325 43 (37.1) 5 (9.4) Ref Ref Age (years) ≤ 40 51 (44.0) 32 (60.4) Ref Ref > 40 65 (56.0) 21 (39.6) 1.23 (0.99–1.52) 0.054 1.07 (0.84–1.54) 0.582 Sex Male 32 (27.6) 14 (26.4) Ref Ref Female 84 (72.4) 39 (73.6) 0.98 (0.78–1.23) 0.873 0.96 (0.77–1.20) 0.721 ASA class 1 104 (89.7) 49 (92.4) Ref Ref 2 to 3 12 (10.3) 4 (7.6) 1.10 (0.81–1.49) 0.525 1.00 (0.76–1.31) 0.978 Ref : Reference category; cRR : Crude risk ratio; aRR : Adjusted risk ratio; ASA : American Society of Anesthesiologists physical status classification; 6MWTD - six-minute walk test distance Discussion In this study, hypotension and bradycardia were the most common intraoperative complications, impacting over one-third of the participants. Remarkably, a short six-minute walk distance emerged as an independent predictor for increased incidence of intraoperative anesthesia complications, with participants covering a shorter distance exhibiting a 40% increased risk compared to their counterparts. Taken together, the findings underscore the importance of integrating the 6MWT into routine preoperative assessments, particularly in low-resource settings, as it could enable the proactive identification of patients at a high risk of experiencing intraoperative anaesthesia complications. The incidence of hypotension in the study was 47.3%. Hypotension is a common occurrence during both general and spinal anesthesia, owing to the induction of vasodilation, leading to decreased systemic vascular resistance( 4 , 22 – 25 ). The incidence of hypotension was higher in studies conducted in Ethiopia 64% ( 26 ) and Croatia 75( 27 ) than ours. The higher incidence observed in the Ethiopian study could be attributed to the inclusion of pregnant mothers experiencing pronounced aortocaval compression, leading to a greater magnitude of hypotension. Furthermore, the Ethiopian study did not account for the practice of prophylactic vasopressor administration, which is common at MRRH( 28 ). Conversely, our study's incidence of severe hypotension was comparable to a study conducted in Japan ( 2 ) randomized controlled trials in India, which recorded incidences of 41.7% and 39.6% ( 29 ). The similarity in incidence can be attributed to the almost identical definition of hypotension used and the similar study population. The incidence of bradycardia was 39.1% in the current study. This may be as a result of a high spinal above T4 to T1 dermatome( 30 ). Such anesthesia causes cardiac sympathectomy, leading to a lack of innervation stimulation for the heart, resulting in bradycardia ( 4 ). Additionally, bradycardia under spinal anesthesia might be linked to baroreceptor activity during episodes of hypertension as a way of controlling it, and the reverse Bainbridge reflex could also cause bradycardia due to reduced stretch of the right atria caused by reduced venous return ( 31 ). Our findings were comparable to those from Germany (45%) ( 32 ) and British Columbia, Canada (35%) ( 4 ). This similarity might be attributed to comparable participant characteristics and the fact that these studies were conducted in university hospitals. In contrast, our results showed higher bradycardia rates compared to studies in India, which reported rates of 16.2% and 11.6% in the two arms of a randomized control trial ( 29 ). This difference could be explained by the definition of bradycardia used in the Indian studies (heart rate < 50 beats per minute), potentially excluding many individuals experiencing bradycardia. In our study, the incidence of hypertension was 34.3%. We observed that most (84.5%) of the hypertension cases were preceded by incidences of hypotension during the operation. This was likely a result of zealous resuscitation and fluid administration by the anesthetists, including the use of vasopressors like epinephrine or ephedrine. The incidence was higher compared to the previous studies that were done in Birmingham, Alabama( 33 ), Serbia (61.4%) ( 3 ) and Belgrade (56.9%) ( 34 ). Our findings underscore the need for further research into diverse anesthesia practices and the development of a standardized approach to manage intraoperative hypotension. The incidence of hypoxia was found to be 6.6% during intraoperative period. This was comparable to studies done in Boston, USA (6.8%)( 5 ). This could be an indicator of the presence of good monitoring for hypoxia and institution of early interventions, such as oxygen supplementation that makes the incidence to be low. A short six-minute walk distance emerged as an independent predictor of increased intraoperative anesthesia complications, with participants covering a shorter distance exhibiting a 40% increased risk compared to their counterparts. The 6MWT assesses the functional capacity of the cardiopulmonary system; this can be a surrogate marker of the body’s oxygen uptake during the stressful environment ( 13 , 14 ). Given the impact of anesthesia drugs on disrupting the body's cardiorespiratory homeostasis, these drugs may interfere with the body's adaptive mechanisms. This disruption can manifest as various intraoperative complications, which may subsequently increase morbidity risk for patients in both the intra and postoperative periods ( 14 , 35 ). Based on the findings of our study, which highlight the association between a short six-minute walk distance and increased incidence of intraoperative complications, we recommend considering assessing the functional capacity of the cardiopulmonary system, which can be evaluated using the six-minute walk test (6MWT), as part of routine preoperative assessment. Patients with a shorter walk distance may be at higher risk for intraoperative complications and require closer monitoring and appropriate interventions. Additionally, anesthesia providers should consider developing an individualized anesthetic plan based on the patient's preoperative assessment, including the evaluation of their walk distance. This may involve selecting anesthetic drugs and techniques that minimize disruption to the body's cardiorespiratory homeostasis and compensatory mechanisms. However, further research is warranted to corroborate these findings and better inform development of evidence-based guidelines for mitigating the risk of anesthesia complications during surgery in our setting. Several limitations should be considered in the interpretation of our findings. Firstly, the study was conducted at a single center, MRRH, which limits the generalizability of our results beyond southwestern Uganda and sub-Saharan African settings. Secondly, the study focused on a narrow range of surgical procedures, introducing a potential limitation in the generalizability of the outcomes to a broader spectrum of surgeries with varying complexities and durations. Larger studies involving a diverse array of surgical procedures are essential to corroborate and extend the robustness of our initial findings. Additionally, the cross-sectional nature that provided a snapshot of intraoperative complications and 6MWT results at a specific point in time, cannot offer insights into the dynamic nature of these relationships over time. To address these limitations, future research endeavors should aim for geographical and population diversity, include a broader spectrum of surgical procedures, and adopt a longitudinal approach to capture the evolving nature of the associations between the six-minute walk distance and perioperative complications. Despite these limitations, our study contributes significantly to the existing literature by pioneering the exploration of the association between the six-minute walk distance and the incidence of intraoperative anesthesia complications in the distinct context of sub-Saharan Africa. Importantly, our study underscores the potential value of implementing this cost-effective tool in resource-limited settings, offering a means to enhance patient outcomes and improve perioperative care. Conclusion In conclusion, this study identified hypotension and bradycardia as the most prevalent intraoperative complications, affecting more than one-third of the participants. Notably, we found that a short six-minute walk distance of ≤ 325 meters emerged as an independent predictor for an increased 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. Abbreviations aRR adjusted risk ratio ASA American society of anesthesiologist cRR crude risk ratio CI Confidence interval ENT Ear Nose and Throat MRRH Mbarara Regional Referral Hospital 6MWT six-minute walk test 6MWTD six-minute walk test distance Declarations Ethical considerations and consent to participate Prior to commencing the research, necessary approvals were obtained from various regulatory bodies, including the Department of Anesthesia and Critical Care at Mbarara University of Science and Technology, the Mbarara University of Science and Technology Research Ethics Committee (Approval number: MUST-2022-748), the Uganda National Council of Science and Technology (Approval number: HS2863ES), and the Hospital Director of Mbarara Regional Referral Hospital. The participants were explicitly informed of their right to refuse participation or to withdraw from the study at any time without facing any adverse consequences. Prior to commencing the study, written informed consent was obtained from all participants, affirming their voluntary willingness to partake in the research, in accordance with the principles of the Helsinki Declaration. Consent for publication Not applicable Availability of data and materials The datasets generated and analysed for this study are available from the corresponding author, upon request. Competing interests The authors declare that they have no competing interests with regard to publication of this work. Funding This study received funding from Mbarara university of science and technology with support from Massachusetts General hospital, USA under the first mile scholarship. Authors’ contributions MS, AK, and RM all contributed to the study conceptualization and design. SM and RM analysed the data. SM drafted the initial manuscript. All authors read and approved the final manuscript. Acknowledgement We express our heartfelt gratitude to our dedicated team of research assistants: Mwanje William, Kakoza Kamya, Murungi Nathan, Oriona Felix, Steve, Nakawungu Proscovia, Sr. Dorothy, and Kule Moses for their invaluable contributions to data collection. Special thanks are extended to Dr. Emmanuel Munyarugero for his expert technical guidance. We also extend our appreciation to the administration of Mbarara Regional Referral Hospital for their unwavering support throughout the study. References Arbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, et al. Impact of anesthesia management characteristics on severe morbidity and mortality. The Journal of the American Society of Anesthesiologists. 2005;102(2):257-68. Katori N, Yamakawa K, Kida K, Kimura Y, Fujioka S, Tsubokawa T. The incidence of hypotension during general anesthesia: a single-center study at a university hospital. JA clinical reports. 2023;9(1):23. Kalezic N, Stojanovic M, Milicic B, Antonijevic V, Sabljak V, Markovic D, et al. The incidence of intraoperative hypertension and risk factors for its development during thyroid surgery. Clinical and experimental hypertension. 2013;35(7):523-7. Cheung CC, Martyn A, Campbell N, Frost S, Gilbert K, Michota F, et al. Predictors of intraoperative hypotension and bradycardia. The American journal of medicine. 2015;128(5):532-8. Ehrenfeld JM, Funk LM, Van Schalkwyk J, Merry AF, Sandberg WS, Gawande A. The incidence of hypoxemia during surgery: evidence from two institutions. Canadian journal of anaesthesia= Journal canadien d'anesthesie. 2010;57(10):888. Juang J, Cordoba M, Xiao M, Ciaramella A, Goldfarb J, Bayter JE, et al. Post-anesthesia care unit desaturation in adult deep extubation patients. BMC Research Notes. 2021;14:1-5. Kleinwächter R, Kork F, Weiss-Gerlach E, Ramme A, Linnen H, Radtke F, et al. Improving the detection of illicit substance use in preoperative anesthesiological assessment. Minerva anestesiologica. 2010;76(1):29. Garcia-Miguel F, Serrano-Aguilar P, Lopez-Bastida J. Preoperative assessment. The Lancet. 2003;362(9397):1749-57. Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. Jama. 2014;311(20):2110-20. Bloomstone JA, Houseman BT, Sande EV, Brantley A, Curran J, Maccioli GA, et al. Documentation of individualized preoperative risk assessment: a multi-center study. Perioperative Medicine. 2020;9(1):1-8. Kellett J, Deane B. The Simple Clinical Score predicts mortality for 30 days after admission to an acute medical unit. Journal of the Association of Physicians. 2006;99(11):771-81. Test SMW. Minute Walk Test–Physiopedia. Six_Minute_Walk_Test_/_6_Minute_Walk_Test. Wang J, Zang Y, Wu Q, She Y, Xu H, Zhang J, et al. Predicting adverse events during six-minute walk test using continuous physiological signals. Frontiers in Physiology. 2022;13. Casano HAM, Anjum F. Six Minute Walk Test. StatPearls [Internet]: StatPearls Publishing; 2021. Enright PL. The six-minute walk test. Respiratory care. 2003;48(8):783-5. Miccichè V, Esposito C, Santaniello W, Scarpati G, Marinosci GZ, De Robertis E, et al. Six-minute walk test in pre-operative evaluation of patients for upper abdominal surgery. European Journal of Anaesthesiology| EJA. 2019;36(2):164-6. Keeratichananont W, Thanadetsuntorn C, Keeratichananont S. Value of preoperative 6-minute walk test for predicting postoperative pulmonary complications. Therapeutic advances in respiratory disease. 2016;10(1):18-25. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian journal of anaesthesia. 2011;55(2):111. Salmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology. 2017;126(1):47-65. Samuel J, Franklin C. Hypoxemia and hypoxia. Common surgical diseases: an algorithmic approach to problem solving. 2008:391-4. Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2019;74(7):e51-e156. Bijker Jilles B, van Klei Wilton A, Kappen Teus H, van Wolfswinkel L, Moons Karel GM, Kalkman Cor J. Incidence of Intraoperative Hypotension as a Function of the Chosen Definition: Literature Definitions Applied to a Retrospective Cohort Using Automated Data Collection. Anesthesiology. 2007;107(2):213-20. Shah NJ, Mentz G, Kheterpal S. The incidence of intraoperative hypotension in moderate to high risk patients undergoing non-cardiac surgery: A retrospective multicenter observational analysis. Journal of Clinical Anesthesia. 2020;66:109961. Vos JJ, Scheeren TW. Intraoperative hypotension and its prediction. Indian journal of anaesthesia. 2019;63(11):877. Wesselink E, Kappen T, Torn H, Slooter A, Van Klei W. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. British journal of anaesthesia. 2018;121(4):706-21. Chekol WB, Melesse DY, Mersha AT. Incidence and factors associated with hypotension in emergency patients that underwent cesarean section with spinal anaesthesia: Prospective observational study. International Journal of Surgery Open. 2021;35:100378. Šklebar I, Bujas T, Habek D. Spinal anaesthesia-induced hypotension in obstetrics: prevention and therapy. Acta clinica Croatica. 2019;58(Suppl 1):90. Lee JE, George RB, Habib AS. Spinal-induced hypotension: Incidence, mechanisms, prophylaxis, and management: Summarizing 20 years of research. Best Practice & Research Clinical Anaesthesiology. 2017;31(1):57-68. SudAn S, KAmAlAKShy RK, RAveendRAn S, SebAStiAn R. Incidence of Intraoperative Hypotension and Bradycardia in Spinal Anaesthesia with 0.5% Bupivacaine alone and 0.5% Bupivacaine with Fentanyl for Abdominal Hysterectomy: A Cross-sectional Study. Journal of Clinical & Diagnostic Research. 2022;16(11). Shaikh N, Rhaman M, Raza A, Shabana A, Malstrom M, Al-Sulaiti G. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management. Asian Journal of Neurosurgery. 2016;11(04):427-32. Crystal GJ, Salem MR. The Bainbridge and the “Reverse” Bainbridge Reflexes: History, Physiology, and Clinical Relevance. Anesthesia & Analgesia. 2012;114(3):520-32. Kouz K, Hoppe P, Reese P, Burfeindt C, Flick M, Briesenick L, et al. Relationship Between Intraoperative and Preoperative Ambulatory Nighttime Heart Rates: A Secondary Analysis of a Prospective Observational Study. Anesthesia & Analgesia. 2021;133(2):406-12. Wallach R, Karp RB, Reves J, Oparil S, Smith LR, James TN. Pathogenesis of paroxysmal hypertension developing during and after coronary bypass surgery: a study of hemodynamic and humoral factors. The American Journal of Cardiology. 1980;46(4):559-65. Sabljak VD, Zivaljevic VR, Milicic BR, Paunovic IR, Toskovic AR, Stevanovic KS, et al. Risk factors for intraoperative hypertension during surgery for primary hyperparathyroidism. Medical Principles and Practice. 2017;26(4):381-6. Troosters T, Vilaro J, Rabinovich R, Casas A, Barbera J, Rodriguez-Roisin R, et al. Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease. European Respiratory Journal. 2002;20(3):564-9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3826364","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":264869802,"identity":"ba2c88f1-910c-47fe-9e53-6d71e15c8aca","order_by":0,"name":"Moses Ssenyonjo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie2QvwrCMBCHrx5cl9OsLVV8hUKhoz5MQZduLoqDg9DVF/A5MisBXQRXQQf/gJNLB0U3U9FJaBwd8g3Jb7iP3C8AFssfg4A43+vAtd8Vl5KwUOj3dwTHXnEbleZELU7c37kCIR5c01adAA/HTYkSbjrdiFdn9MfQ2TZkohejKErLFI/joJopDBUstr5ErTAFZUpzsr69FSfr+XJkVmCW0ltBcnKpzIruEvvTldJdCANHLpnQ0EX/2Nm79FUixDrPH3LYFu74cCpdTFNhgKQIyK/TMF7g3AFan2CxWCyWL57MND+n7/57fwAAAABJRU5ErkJggg==","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Moses","middleName":"","lastName":"Ssenyonjo","suffix":""},{"id":264869803,"identity":"b0df46fa-6e6e-4f8e-b07b-1a3ba73c40a2","order_by":1,"name":"Andrew Kwikiriza","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Kwikiriza","suffix":""},{"id":264869804,"identity":"cd6e980b-a37a-4773-bf64-9bd74faa4738","order_by":2,"name":"Richard Migisha","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"","lastName":"Migisha","suffix":""}],"badges":[],"createdAt":"2023-12-31 18:14:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3826364/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3826364/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49140005,"identity":"917ab475-43ac-456a-b70d-42c812503c64","added_by":"auto","created_at":"2024-01-03 18:15:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45176,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart for recruitment of study participants\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3826364/v1/314a78650492c9ace6b55941.png"},{"id":49140006,"identity":"1e9f26b2-edb2-4fda-a3cf-57a4f8caee4d","added_by":"auto","created_at":"2024-01-03 18:15:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32766,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIncidence of intraoperative anesthesia complications among patients undergoing elective surgeries at Mbarara Regional Referral Hospital, Uganda, January–May 2023\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3826364/v1/d54db755ce978c69ca943c26.png"},{"id":60006872,"identity":"6ce60881-4606-488b-af9a-5f06ab0456cb","added_by":"auto","created_at":"2024-07-10 12:07:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":927941,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3826364/v1/37027eb0-cd59-4ac3-9d02-7aeeb51a693f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Six-minute walk test as a predictor for intraoperative anesthesia complications: a prospective cohort at a tertiary hospital, southwestern Uganda","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntraoperative anesthesia complications significantly contribute to perioperative morbidity and mortality, making them crucial performance indicators for surgical theaters(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). These complications encompass single or multiple occurences of hypotension, bradycardia, hypertension, hypoxia, or post-extubation desaturation during the intraoperative period. Various studies have documented their incidences as follows: hypotension at 48.8% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), hypertension at 61.4%(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), bradycardia at 35% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), hypoxia at 6.8%(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and post-extubation desaturation at 4.3% (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePreoperative assessment plays a crucial role in identifying high-risk patients for optimal intraoperative care (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Individualized care and prior optimization based on these assessments have been associated with improved patient outcomes (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). While widely used in medical practice, tools like the simplified acute physiological score or acute physiological and chronic health evaluation score have not been extensively applied in surgical settings (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These have faced challenges in low-income setting due to battery of investigations and higher skill set that may be required to interpret the results, limiting their applicability.\u003c/p\u003e \u003cp\u003eThe 6-minute walk test (6MWT) is a cost-effective, easily reproducible, and validated tool for predicting postoperative complications, as supported by various studies (\u003cspan additionalcitationids=\"CR13 CR14 CR15\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Notably, a distance threshold of \u0026le;\u0026thinsp;325 meters has been shown to be indicative of increased risk for postoperative respiratory complications (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These findings suggest the potential significance of the 6MWT in preoperative risk stratification and warrant further exploration of its utility in surgical settings. However, no previous study, to the best of our knowledge, has explored this specific association of the 6MWT in the context of intraoperative complications.\u003c/p\u003e \u003cp\u003eIn Uganda, anesthetists currently rely on the American Society of Anesthesiologists (ASA) physical status classification to stratify patients, but this approach has inherent challenges as it is subjective and may not consider all relevant factors, such as the patient's vitals, medical history, and medication history (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Consequently, providing individualized care based solely on this classification can be inadequate, leading to potential predisposition of patients to intraoperative anesthesia complications. Moreover, the incomplete filling of anesthesia forms presents an additional challenge, resulting in the failure to accurately estimate the incidences of intraoperative complications. To address these gaps, we determined the incidence of intraoperative anesthesia complications and evaluated the association between the 6MWT and incidence intraoperative anesthesia complications among patients undergoing elective surgeries at Mbarara Regional Referral Hospital in southwestern Uganda.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003e This was a prospective cohort study, conducted at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda from January 17, 2023 to May 19, 2023. MRRH is located approximately 290 kilometers (180 miles) southwest of Kampala, Uganda's capital city. The hospital serves as the referral center for several districts in Uganda, including Mbarara, Isingiro, Bushenyi, Ntungamo, Kiruhura, and Ibanda, and has a catchment population of approximately four million people. The surgical theater records approximately 50 elective cases each month. Although perioperative assessments involve systematic clinical examinations, there is no routine utilization of risk stratification tools to assess patients for intraoperative or postoperative complications. The ASA classification is the only tool occasionally employed in this regard.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eParticipants were adult patients undergoing non-neurological elective surgery recruited from various wards, such as surgery and gynecology wards of MRRH. We included patients aged 18 years or older who were scheduled for elective surgery and had a Glasgow Coma Scale score of 15. Patients who refused to provide consent, those with orthopedic conditions affecting walking ability, persons listed on the theater schedule but not operated on, and those who had experienced and received treatment for myocardial infarction within the past three months were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size estimation and sampling\u003c/h2\u003e \u003cp\u003e To determine the required sample size, we estimated a population size of 305 elective surgeries performed over a 6-month period, as obtained from the theater records. Since no incidence data for a similar population was available, we assumed a hypothesized percentage frequency of the outcome factor at 50% with a margin of error of \u0026plusmn;\u0026thinsp;5%. Utilizing a confidence level of 95%, a design effect of 1, and the single proportion formula for sample size calculation, we calculated a sample size of 169 participants. The sample size calculation was performed using OpenEpi, Version 3, an open-source calculator.\u003c/p\u003e \u003cp\u003eFor the study sampling, we used consecutive sampling, in which every subject who met the inclusion criteria until the required sample size of 169 participants was achieved.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection and study procedures\u003c/h2\u003e \u003cp\u003eUpon release of the theater lists from various departments, research assistants actively searched for eligible patients on different wards, including surgery and gynecology. Informed consent was obtained from participants in their native language, Runyankole, or English, by research assistants proficient in both languages. The research assistants, who were medical doctors, also provided detailed explanations of the study procedure, benefits, contraindications, and the 6MWT before enrolling participants.\u003c/p\u003e \u003cp\u003ePatient demographics, including age, sex, occupation, and location, were recorded following consent. Medical histories were collected, encompassing conditions like heart failure, hypertension, as well as behavioral practices such as smoking and alcohol consumption. Resting blood pressure, oxygen saturation, and pulse rate readings were taken.\u003c/p\u003e \u003cp\u003ePatients were classified based on the ASA physical status classification, and their medical histories were documented. They were instructed to wear comfortable clothing and footwear, rest for at least 15 minutes, and undergo routine clinical procedures for measuring blood pressure, heart rate, and oxygen saturation.\u003c/p\u003e \u003cp\u003eThe six-minute walk test was conducted in several stages, involving area setup, standardized instructions to all patients, and continuous monitoring throughout the exercise. Patients were encouraged to cover the greatest distance within six minutes, along a point-to-point distance of 30 meters, with a chair placed at one end. The environment was maintained at a comfortable ambient temperature and humidity.\u003c/p\u003e \u003cp\u003eEssential equipment, such as a stopwatch, pulse oximeter, emergency tools, and a clipboard with a pen for recording findings, were in place. Standardized instructions and encouragement were provided to patients, emphasizing walking without running or jogging. Patients were allowed to rest as needed, and time was recorded without stopping the stopwatch. Encouragement was given based on elapsed time, such as \"You're doing great, five minutes to go\" at one-minute mark, and \"You are doing great, one minute to go\" at five minutes.\u003c/p\u003e \u003cp\u003eUpon completing the exercise, oxygen saturation, pulse rate, and modified dyspnea scale readings were recorded. Reasons for resting during the exercise were noted, and if oxygen saturation was above 85%, encouragement was provided every 15 seconds after resting.\u003c/p\u003e \u003cp\u003eDuring the intraoperative period, patients' blood pressure, oxygen saturation, and pulse rate were documented from their anesthetic chart tables and added to their follow-up documents as part of the study. Additional data, such as the lowest and highest blood pressure, lowest saturation, and occurrences of desaturation, hypotension, or hypertension at extubation, were captured.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eOperational definitions\u003c/h2\u003e \u003cp\u003eThe criteria for defining specific intraoperative complications were as follows: hypotension was characterized by a 20% reduction in mean arterial pressure from baseline (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), hypertension was identified as a 20% increase in mean arterial blood pressure, hypoxia was indicated by a saturation level below 95% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e); bradycardia was defined as a pulse rate less than 60 beats per minute(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), and desaturation after extubation was identified as a saturation level below 90% for \u0026gt;\u0026thinsp;10 seconds(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). A short six-minute walk distance was defined as a distance of 325 meters or less, as established in a previous study(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData management and statistical analysis\u003c/h2\u003e \u003cp\u003eAn Excel data tool was used to collect the data, and the data were later exported to STATA version 15 (StataCorp, College Station, Texas, USA) for analysis.\u003c/p\u003e \u003cp\u003eWe first described the characteristics of the study participants, categorical demographic and clinical variables using frequencies and percentages. We compared the participants\u0026rsquo; characteristics between those who walked\u0026thinsp;\u0026gt;\u0026thinsp;325 meters and those who walked\u0026thinsp;\u0026le;\u0026thinsp;325 meters using Chi square test or Fischer\u0026rsquo;s exact test. Variables that exhibited a significant distribution difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), those with biological plausibility (e.g., sex and ASA classification), were subsequently adjusted for in the multivariable log-binomial regression analysis, to determine the association between the six-minute walk distance (main exposure variable), and the occurrence of intraoperative complications. The associations were quantified as adjusted risk ratios (aRRs) accompanied by their respective 95% confidence intervals (CIs).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe total number of 188 elective surgery cases were enrolled in the study. Of these, 19 were excluded because they were not operated; 169 patients were followed-up and discharged from the cohort after the intraoperative period (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eCharacteristics of study participants\u003c/strong\u003e\u003c/p\u003e \u003cp\u003eOf the 169 participants, 48 (28%) covered a distance of \u0026le;\u0026thinsp;325 meters during the 6MWT, while 121 participants (72%) covered a distance of \u0026gt;\u0026thinsp;325 meters. Regarding age, participants aged\u0026thinsp;\u0026le;\u0026thinsp;40 years accounted for 49.1% of the total cohort, with 16.7% of them having a short 6MWT distance. In contrast, participants above 40 years old constituted 50.9% of the cohort, of which 83.3% had a short 6MWT distance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The median age of the participants was 41 years (inter-quartile range [IQR]: 30\u0026ndash;55 years) with more females (72.8%) than males (27.2%). Most of the patients had attained primary level education (46.8%); the majority had an ASA classification of one (90.5%). Most participants predominately resided in the rural areas (72%) and mostly received spinal anesthesia (77.5%) during their elective surgeries (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All the characteristics did not show any significant differences between the two groups, except for age.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eCharacteristics of study participants, by six-minute walk distance covered preoperatively\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal cohort (N\u0026thinsp;=\u0026thinsp;169),\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSix-minute walk (meters)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;325 (n\u0026thinsp;=\u0026thinsp;48),\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;28 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;325 (n\u0026thinsp;=\u0026thinsp;121),\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;72(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge* (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75 (62.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46 (38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(72.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59 (48.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA class\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(90.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e113 (93.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of anesthesia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (72.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96 (79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal \u0026amp; general\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynecological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (32.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eENT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(72.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (80.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83 (68.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of smoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of alcohol consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of chronic illnesses**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of allergies\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResting heart rate (beats per minute)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(75.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91 (75.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(21.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostural hypotension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e*\u003c/b\u003eMedian age\u0026thinsp;=\u0026thinsp;41 years (IQR, 30\u0026ndash;55 years); \u003cb\u003eENT\u003c/b\u003e: Ear Nose and Throat;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA\u003c/b\u003e: American Society of Anesthesiologists physical status classification; \u003cb\u003e**\u003c/b\u003eChronic illnesses include HIV (n\u0026thinsp;=\u0026thinsp;14), peptic ulcer disease (n\u0026thinsp;=\u0026thinsp;12), hypertension (n\u0026thinsp;=\u0026thinsp;8), diabetes (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eIntraoperative anesthesia complications\u003c/h2\u003e \u003cp\u003eAmong 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 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among the 58 participants with hypertension as a complication, the majority (n\u0026thinsp;=\u0026thinsp;49; 84.5%) were observed after an episode of hypotension.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between the 6-minute walk test and intraoperative anesthesia complications\u003c/h2\u003e \u003cp\u003eAfter controlling for age, sex, and ASA class, the six-minute walk distance was an independent predictor for intraoperative complications. Participants who walked shorter distance (\u0026le;\u0026thinsp;325 meters) had 1.4 times (aRR\u0026thinsp;=\u0026thinsp;1.44, 95% CI: 1.18\u0026ndash;1.77, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) higher risk of experiencing intraoperative anesthesia complications compared to those who walked longer distance (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between six-minute walk distance and intraoperative anesthesia complications among patients undergoing elective surgeries at Mbarara Regional Referral Hospital, Uganda, January\u0026ndash;May 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIntraoperative Complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eUnadjusted analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAdjusted analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;116),\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;53),\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ecRR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eaRR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e6MWTD (meters)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (90.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.48 (1.25\u0026ndash;1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.44 (1.18\u0026ndash;1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (56.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.23 (0.99\u0026ndash;1.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.07 (0.84\u0026ndash;1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (73.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98 (0.78\u0026ndash;1.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.96 (0.77\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA class\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (89.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (92.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 to 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.10 (0.81\u0026ndash;1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00 (0.76\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e: Reference category; \u003cb\u003ecRR\u003c/b\u003e: Crude risk ratio; \u003cb\u003eaRR\u003c/b\u003e: Adjusted risk ratio; \u003cb\u003eASA\u003c/b\u003e: American Society of Anesthesiologists physical status classification; \u003cb\u003e6MWTD\u003c/b\u003e- six-minute walk test distance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, hypotension and bradycardia were the most common intraoperative complications, impacting over one-third of the participants. Remarkably, a short six-minute walk distance emerged as an independent predictor for increased incidence of intraoperative anesthesia complications, with participants covering a shorter distance exhibiting a 40% increased risk compared to their counterparts. Taken together, the findings underscore the importance of integrating the 6MWT into routine preoperative assessments, particularly in low-resource settings, as it could enable the proactive identification of patients at a high risk of experiencing intraoperative anaesthesia complications.\u003c/p\u003e \u003cp\u003eThe incidence of hypotension in the study was 47.3%. Hypotension is a common occurrence during both general and spinal anesthesia, owing to the induction of vasodilation, leading to decreased systemic vascular resistance(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The incidence of hypotension was higher in studies conducted in Ethiopia 64% (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and Croatia 75(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) than ours. The higher incidence observed in the Ethiopian study could be attributed to the inclusion of pregnant mothers experiencing pronounced aortocaval compression, leading to a greater magnitude of hypotension. Furthermore, the Ethiopian study did not account for the practice of prophylactic vasopressor administration, which is common at MRRH(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Conversely, our study's incidence of severe hypotension was comparable to a study conducted in Japan (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) randomized controlled trials in India, which recorded incidences of 41.7% and 39.6% (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The similarity in incidence can be attributed to the almost identical definition of hypotension used and the similar study population.\u003c/p\u003e \u003cp\u003eThe incidence of bradycardia was 39.1% in the current study. This may be as a result of a high spinal above T4 to T1 dermatome(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Such anesthesia causes cardiac sympathectomy, leading to a lack of innervation stimulation for the heart, resulting in bradycardia (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Additionally, bradycardia under spinal anesthesia might be linked to baroreceptor activity during episodes of hypertension as a way of controlling it, and the reverse Bainbridge reflex could also cause bradycardia due to reduced stretch of the right atria caused by reduced venous return (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Our findings were comparable to those from Germany (45%) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and British Columbia, Canada (35%) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This similarity might be attributed to comparable participant characteristics and the fact that these studies were conducted in university hospitals. In contrast, our results showed higher bradycardia rates compared to studies in India, which reported rates of 16.2% and 11.6% in the two arms of a randomized control trial (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This difference could be explained by the definition of bradycardia used in the Indian studies (heart rate\u0026thinsp;\u0026lt;\u0026thinsp;50 beats per minute), potentially excluding many individuals experiencing bradycardia.\u003c/p\u003e \u003cp\u003eIn our study, the incidence of hypertension was 34.3%. We observed that most (84.5%) of the hypertension cases were preceded by incidences of hypotension during the operation. This was likely a result of zealous resuscitation and fluid administration by the anesthetists, including the use of vasopressors like epinephrine or ephedrine. The incidence was higher compared to the previous studies that were done in Birmingham, Alabama(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), Serbia (61.4%) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) and Belgrade (56.9%) (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Our findings underscore the need for further research into diverse anesthesia practices and the development of a standardized approach to manage intraoperative hypotension.\u003c/p\u003e \u003cp\u003eThe incidence of hypoxia was found to be 6.6% during intraoperative period. This was comparable to studies done in Boston, USA (6.8%)(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This could be an indicator of the presence of good monitoring for hypoxia and institution of early interventions, such as oxygen supplementation that makes the incidence to be low.\u003c/p\u003e \u003cp\u003eA short six-minute walk distance emerged as an independent predictor of increased intraoperative anesthesia complications, with participants covering a shorter distance exhibiting a 40% increased risk compared to their counterparts. The 6MWT assesses the functional capacity of the cardiopulmonary system; this can be a surrogate marker of the body\u0026rsquo;s oxygen uptake during the stressful environment (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Given the impact of anesthesia drugs on disrupting the body's cardiorespiratory homeostasis, these drugs may interfere with the body's adaptive mechanisms. This disruption can manifest as various intraoperative complications, which may subsequently increase morbidity risk for patients in both the intra and postoperative periods (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBased on the findings of our study, which highlight the association between a short six-minute walk distance and increased incidence of intraoperative complications, we recommend considering assessing the functional capacity of the cardiopulmonary system, which can be evaluated using the six-minute walk test (6MWT), as part of routine preoperative assessment. Patients with a shorter walk distance may be at higher risk for intraoperative complications and require closer monitoring and appropriate interventions. Additionally, anesthesia providers should consider developing an individualized anesthetic plan based on the patient's preoperative assessment, including the evaluation of their walk distance. This may involve selecting anesthetic drugs and techniques that minimize disruption to the body's cardiorespiratory homeostasis and compensatory mechanisms. However, further research is warranted to corroborate these findings and better inform development of evidence-based guidelines for mitigating the risk of anesthesia complications during surgery in our setting.\u003c/p\u003e \u003cp\u003eSeveral limitations should be considered in the interpretation of our findings. Firstly, the study was conducted at a single center, MRRH, which limits the generalizability of our results beyond southwestern Uganda and sub-Saharan African settings. Secondly, the study focused on a narrow range of surgical procedures, introducing a potential limitation in the generalizability of the outcomes to a broader spectrum of surgeries with varying complexities and durations. Larger studies involving a diverse array of surgical procedures are essential to corroborate and extend the robustness of our initial findings. Additionally, the cross-sectional nature that provided a snapshot of intraoperative complications and 6MWT results at a specific point in time, cannot offer insights into the dynamic nature of these relationships over time. To address these limitations, future research endeavors should aim for geographical and population diversity, include a broader spectrum of surgical procedures, and adopt a longitudinal approach to capture the evolving nature of the associations between the six-minute walk distance and perioperative complications. Despite these limitations, our study contributes significantly to the existing literature by pioneering the exploration of the association between the six-minute walk distance and the incidence of intraoperative anesthesia complications in the distinct context of sub-Saharan Africa. Importantly, our study underscores the potential value of implementing this cost-effective tool in resource-limited settings, offering a means to enhance patient outcomes and improve perioperative care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study identified hypotension and bradycardia as the most prevalent intraoperative complications, affecting more than one-third of the participants. Notably, we found that a short six-minute walk distance of \u0026le;\u0026thinsp;325 meters emerged as an independent predictor for an increased 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.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eaRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eadjusted risk ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican society of anesthesiologist\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ecRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecrude risk ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eENT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEar Nose and Throat\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMRRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMbarara Regional Referral Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e6MWT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esix-minute walk test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e6MWTD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esix-minute walk test distance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to commencing the research, necessary approvals were\u0026nbsp;obtained\u0026nbsp;from various regulatory bodies, including the Department of Anesthesia and Critical Care at Mbarara University of Science and Technology, the Mbarara University of Science and Technology Research Ethics Committee (Approval number: MUST-2022-748), the Uganda National Council of Science and Technology (Approval number: HS2863ES), and the Hospital Director of Mbarara Regional Referral Hospital.\u0026nbsp;The\u0026nbsp;participants were explicitly informed of their right to refuse participation or to withdraw from the study at any time without facing any adverse consequences. Prior to commencing the study, written informed consent was obtained from all participants, affirming their voluntary willingness to partake in the research, in accordance with the principles of the Helsinki Declaration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed for\u0026nbsp;this study are available from the corresponding author, upon request.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u0026nbsp;with regard to publication of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received funding from Mbarara university of science and technology with support from Massachusetts General hospital, USA under the first mile scholarship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMS, AK, and RM all contributed to the study conceptualization and design. SM and RM analysed the data. SM drafted the initial manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe express our heartfelt gratitude to our dedicated team of research assistants: Mwanje William, Kakoza Kamya, Murungi Nathan, Oriona Felix, Steve, Nakawungu Proscovia, Sr. Dorothy, and Kule Moses for their invaluable contributions to data collection. Special thanks are extended to Dr. Emmanuel Munyarugero for his expert technical guidance. We also extend our appreciation to the administration of Mbarara Regional Referral Hospital for their unwavering support throughout the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, et al. Impact of anesthesia management characteristics on severe morbidity and mortality. The Journal of the American Society of Anesthesiologists. 2005;102(2):257-68.\u003c/li\u003e\n\u003cli\u003eKatori N, Yamakawa K, Kida K, Kimura Y, Fujioka S, Tsubokawa T. The incidence of hypotension during general anesthesia: a single-center study at a university hospital. JA clinical reports. 2023;9(1):23.\u003c/li\u003e\n\u003cli\u003eKalezic N, Stojanovic M, Milicic B, Antonijevic V, Sabljak V, Markovic D, et al. The incidence of intraoperative hypertension and risk factors for its development during thyroid surgery. Clinical and experimental hypertension. 2013;35(7):523-7.\u003c/li\u003e\n\u003cli\u003eCheung CC, Martyn A, Campbell N, Frost S, Gilbert K, Michota F, et al. Predictors of intraoperative hypotension and bradycardia. The American journal of medicine. 2015;128(5):532-8.\u003c/li\u003e\n\u003cli\u003eEhrenfeld JM, Funk LM, Van Schalkwyk J, Merry AF, Sandberg WS, Gawande A. The incidence of hypoxemia during surgery: evidence from two institutions. Canadian journal of anaesthesia= Journal canadien d\u0026apos;anesthesie. 2010;57(10):888.\u003c/li\u003e\n\u003cli\u003eJuang J, Cordoba M, Xiao M, Ciaramella A, Goldfarb J, Bayter JE, et al. Post-anesthesia care unit desaturation in adult deep extubation patients. BMC Research Notes. 2021;14:1-5.\u003c/li\u003e\n\u003cli\u003eKleinw\u0026auml;chter R, Kork F, Weiss-Gerlach E, Ramme A, Linnen H, Radtke F, et al. Improving the detection of illicit substance use in preoperative anesthesiological assessment. Minerva anestesiologica. 2010;76(1):29.\u003c/li\u003e\n\u003cli\u003eGarcia-Miguel F, Serrano-Aguilar P, Lopez-Bastida J. Preoperative assessment. The Lancet. 2003;362(9397):1749-57.\u003c/li\u003e\n\u003cli\u003eOresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. Jama. 2014;311(20):2110-20.\u003c/li\u003e\n\u003cli\u003eBloomstone JA, Houseman BT, Sande EV, Brantley A, Curran J, Maccioli GA, et al. Documentation of individualized preoperative risk assessment: a multi-center study. Perioperative Medicine. 2020;9(1):1-8.\u003c/li\u003e\n\u003cli\u003eKellett J, Deane B. The Simple Clinical Score predicts mortality for 30 days after admission to an acute medical unit. Journal of the Association of Physicians. 2006;99(11):771-81.\u003c/li\u003e\n\u003cli\u003eTest SMW. Minute Walk Test\u0026ndash;Physiopedia. Six_Minute_Walk_Test_/_6_Minute_Walk_Test.\u003c/li\u003e\n\u003cli\u003eWang J, Zang Y, Wu Q, She Y, Xu H, Zhang J, et al. Predicting adverse events during six-minute walk test using continuous physiological signals. Frontiers in Physiology. 2022;13.\u003c/li\u003e\n\u003cli\u003eCasano HAM, Anjum F. Six Minute Walk Test. StatPearls [Internet]: StatPearls Publishing; 2021.\u003c/li\u003e\n\u003cli\u003eEnright PL. The six-minute walk test. Respiratory care. 2003;48(8):783-5.\u003c/li\u003e\n\u003cli\u003eMiccich\u0026egrave; V, Esposito C, Santaniello W, Scarpati G, Marinosci GZ, De Robertis E, et al. Six-minute walk test in pre-operative evaluation of patients for upper abdominal surgery. European Journal of Anaesthesiology| EJA. 2019;36(2):164-6.\u003c/li\u003e\n\u003cli\u003eKeeratichananont W, Thanadetsuntorn C, Keeratichananont S. Value of preoperative 6-minute walk test for predicting postoperative pulmonary complications. Therapeutic advances in respiratory disease. 2016;10(1):18-25.\u003c/li\u003e\n\u003cli\u003eDaabiss M. American Society of Anaesthesiologists physical status classification. Indian journal of anaesthesia. 2011;55(2):111.\u003c/li\u003e\n\u003cli\u003eSalmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology. 2017;126(1):47-65.\u003c/li\u003e\n\u003cli\u003eSamuel J, Franklin C. Hypoxemia and hypoxia. Common surgical diseases: an algorithmic approach to problem solving. 2008:391-4.\u003c/li\u003e\n\u003cli\u003eKusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2019;74(7):e51-e156.\u003c/li\u003e\n\u003cli\u003eBijker Jilles B, van Klei Wilton A, Kappen Teus H, van Wolfswinkel L, Moons Karel GM, Kalkman Cor J. Incidence of Intraoperative Hypotension as a Function of the Chosen Definition: Literature Definitions Applied to a Retrospective Cohort Using Automated Data Collection. Anesthesiology. 2007;107(2):213-20.\u003c/li\u003e\n\u003cli\u003eShah NJ, Mentz G, Kheterpal S. The incidence of intraoperative hypotension in moderate to high risk patients undergoing non-cardiac surgery: A retrospective multicenter observational analysis. Journal of Clinical Anesthesia. 2020;66:109961.\u003c/li\u003e\n\u003cli\u003eVos JJ, Scheeren TW. Intraoperative hypotension and its prediction. Indian journal of anaesthesia. 2019;63(11):877.\u003c/li\u003e\n\u003cli\u003eWesselink E, Kappen T, Torn H, Slooter A, Van Klei W. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. British journal of anaesthesia. 2018;121(4):706-21.\u003c/li\u003e\n\u003cli\u003eChekol WB, Melesse DY, Mersha AT. Incidence and factors associated with hypotension in emergency patients that underwent cesarean section with spinal anaesthesia: Prospective observational study. International Journal of Surgery Open. 2021;35:100378.\u003c/li\u003e\n\u003cli\u003e\u0026Scaron;klebar I, Bujas T, Habek D. Spinal anaesthesia-induced hypotension in obstetrics: prevention and therapy. Acta clinica Croatica. 2019;58(Suppl 1):90.\u003c/li\u003e\n\u003cli\u003eLee JE, George RB, Habib AS. Spinal-induced hypotension: Incidence, mechanisms, prophylaxis, and management: Summarizing 20 years of research. Best Practice \u0026amp; Research Clinical Anaesthesiology. 2017;31(1):57-68.\u003c/li\u003e\n\u003cli\u003eSudAn S, KAmAlAKShy RK, RAveendRAn S, SebAStiAn R. Incidence of Intraoperative Hypotension and Bradycardia in Spinal Anaesthesia with 0.5% Bupivacaine alone and 0.5% Bupivacaine with Fentanyl for Abdominal Hysterectomy: A Cross-sectional Study. Journal of Clinical \u0026amp; Diagnostic Research. 2022;16(11).\u003c/li\u003e\n\u003cli\u003eShaikh N, Rhaman M, Raza A, Shabana A, Malstrom M, Al-Sulaiti G. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management. Asian Journal of Neurosurgery. 2016;11(04):427-32.\u003c/li\u003e\n\u003cli\u003eCrystal GJ, Salem MR. The Bainbridge and the \u0026ldquo;Reverse\u0026rdquo; Bainbridge Reflexes: History, Physiology, and Clinical Relevance. Anesthesia \u0026amp; Analgesia. 2012;114(3):520-32.\u003c/li\u003e\n\u003cli\u003eKouz K, Hoppe P, Reese P, Burfeindt C, Flick M, Briesenick L, et al. Relationship Between Intraoperative and Preoperative Ambulatory Nighttime Heart Rates: A Secondary Analysis of a Prospective Observational Study. Anesthesia \u0026amp; Analgesia. 2021;133(2):406-12.\u003c/li\u003e\n\u003cli\u003eWallach R, Karp RB, Reves J, Oparil S, Smith LR, James TN. Pathogenesis of paroxysmal hypertension developing during and after coronary bypass surgery: a study of hemodynamic and humoral factors. The American Journal of Cardiology. 1980;46(4):559-65.\u003c/li\u003e\n\u003cli\u003eSabljak VD, Zivaljevic VR, Milicic BR, Paunovic IR, Toskovic AR, Stevanovic KS, et al. Risk factors for intraoperative hypertension during surgery for primary hyperparathyroidism. Medical Principles and Practice. 2017;26(4):381-6.\u003c/li\u003e\n\u003cli\u003eTroosters T, Vilaro J, Rabinovich R, Casas A, Barbera J, Rodriguez-Roisin R, et al. Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease. European Respiratory Journal. 2002;20(3):564-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"intraoperative anesthesia complications, 6-minute walk test, 6-minute walk distance","lastPublishedDoi":"10.21203/rs.3.rs-3826364/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3826364/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e 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 (\u0026ge;\u0026thinsp;20% reduction in mean arterial pressure [MAP]), hypertension (\u0026ge;\u0026thinsp;20% increase in MAP), bradycardia and hypoxia. Prior to surgery patients underwent a 6MWT; a distance\u0026thinsp;\u0026le;\u0026thinsp;325 meters was considered short. Additional data were collected on patients\u0026rsquo; 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e We enrolled 169 participants with a median age of 41 years (IQR, 30\u0026ndash;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]\u0026thinsp;=\u0026thinsp;1.44, 95%CI: 1.18\u0026ndash;1.77, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) among patients who walked\u0026thinsp;\u0026le;\u0026thinsp;325 meters preoperatively than those who walked\u0026thinsp;\u0026gt;\u0026thinsp;325 meters preoperatively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"Six-minute walk test as a predictor for intraoperative anesthesia complications: a prospective cohort at a tertiary hospital, southwestern Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-03 18:15:50","doi":"10.21203/rs.3.rs-3826364/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"827b2f42-4f9d-45d7-9642-498b0e4f46a3","owner":[],"postedDate":"January 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-10T11:59:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-03 18:15:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3826364","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3826364","identity":"rs-3826364","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}