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Slower Walking Speed Forecasts Increased Postoperative Morbidity and 1-Year Mortality across Surgical Specialties

Robinson, Thomas N. MD, MS*,¶; Wu, Daniel S. MD*,¶; Sauaia, Angela MD, PhD; Dunn, Christina L. BA*; Stevens-Lapsley, Jennifer E. PT, PhD; Moss, Marc MD; Stiegmann, Greg V. MD*,¶; Gajdos, Csaba MD*; Cleveland, Joseph C. Jr MD*,¶; Inouye, Sharon K. MD, MPH§

doi: 10.1097/SLA.0b013e3182a4e96c
Papers of the 133rd ASA Annual Meeting
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Objective: The purpose of this study was to determine the relationship between the Timed Up and Go test and postoperative morbidity and 1-year mortality, and to compare the Timed Up and Go to the standard-of-care surgical risk calculators for prediction of postoperative complications.

Methods: In this prospective cohort study, patients 65 years and older undergoing elective colorectal and cardiac operations with a minimum of 1-year follow-up were included. The Timed Up and Go test was performed preoperatively. This timed test starts with the subject standing from a chair, walking 10 feet, returning to the chair, and ends after the subject sits. Timed Up and Go results were grouped as fast ≤ 10 seconds, intermediate = 11–14 seconds, and slow ≥ 15 seconds. Receiver operating characteristic curves were used to compare the 3 Timed Up and Go groups to current standard-of-care surgical risk calculators at forecasting postoperative complications.

Results: This study included 272 subjects (mean age of 74 ± 6 years). Slower Timed Up and Go was associated with increased postoperative complications after colorectal (fast 13%, intermediate 29%, and slow 77%; P < 0.001) and cardiac (fast 11%, intermediate 26%, and slow 52%; P < 0.001) operations. Slower Timed Up and Go was associated with increased 1-year mortality following both colorectal (fast 3%, intermediate 10%, and slow 31%; P = 0.006) and cardiac (fast 2%, intermediate 3%, and slow 12%; P = 0.039) operations. Receiver operating characteristic area under curve of the Timed Up and Go and the risk calculators for the colorectal group was 0.775 (95% CI: 0.670–0.880) and 0.554 (95% CI: 0.499–0.609), and for the cardiac group was 0.684 (95% CI: 0.603–0.766) and 0.552 (95% CI: 0.477–0.626).

Conclusions: Slower Timed Up and Go forecasted increased postoperative complications and 1-year mortality across surgical specialties. Regardless of operation performed, the Timed Up and Go compared favorably to the more complex risk calculators at forecasting postoperative complications.

Supplemental Digital Content is Available in the Text.Slower walking speed measured by the Timed Up and Go test forecasts increased risk of postoperative complications and 1-year mortality in older adults following both elective colorectal and cardiac operations. Regardless of operation performed, slower Timed Up and Go compared favorably to the more complex standard-of-care surgical risk calculators at forecasting postoperative complications.

*Department of Surgery

School of Public Health

Department of Physical Medicine and Rehabilitation Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO

§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and Institute for Aging Research, Hebrew SeniorLife, Boston, MA

Department of Surgery, Denver Veteran Affairs Medical Center, Denver, CO.

Reprints: Thomas N. Robinson, MD, MS, 12631 East 17th Avenue, MS C313, Aurora, CO 80045. E-mail: thomas.robinson@ucdenver.edu.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

Disclosure: The awards received by the authors from different institutions are as follows: Paul B. Beeson Award—NIA K23AG034632 (TNR); Dennis W. Jahnigen Award—American Geriatrics Society (TNR); NIH K24-HL-089223 (MM); and NIH P01AG031720 (SKI). Dr Inouye is supported by the Milton and Shirley F. Levy Family Chair. The authors have no conflicts of interest to disclose.

© 2013 by Lippincott Williams & Wilkins.