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Slower Walking Speed Forecasts Increased Postoperative Morbidity and One-Year Mortality Across Surgical Specialties
Thomas N Robinson*, Christina L Dunn*, Angela Sauaia*, Jennifer Stevens-Lapley*, Greg V Stiegmann, Marc Moss*
University of Colorado, Aurora, CO

INTRODUCTION: Slower walking speed, a marker of frailty, has been related to adverse healthcare outcomes in older adults. The PURPOSE of this study was to determine the relationship between walking speed and postoperative morbidity and one-year mortality, and to compare walking speed to current standard-of-care preoperative surgical risk calculators at forecasting postoperative morbidity.
METHODS: In this prospective cohort study, consecutive patients 65 years and older undergoing elective colorectal and cardiac operations with a minimum of one-year follow-up were included. Preoperatively, the timed-up-and-go was performed. This timed test starts with the subject standing from a chair, walking ten feet, returning to the chair and ends after the subject sits. Timed-up-and-go results were stratified ordinally (FAST<=10 sec, INTERMEDIATE=11-14 sec, SLOW>=15 sec). Postoperative complications were quantified prospectively using standardized definitions. Receiver operating characteristic curves were used to compare the three 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). Intra-operative variables were similar in the three timed-up-and-go groups.
FAST
<= 10 sec.
INTERMEDIATE
11 – 14 Sec.
SLOW
>=15 sec
p-value
COLORECTAL (n=98)
>=1 Complication13% (4/30)29% (12/42)77% (20/26)<0.001
One-Year Mortality3% (1/30)10% (4/42)35% (9/26)0.006
CARDIAC (n=174)
>=1 Complication11% (6/53)25% (23/89)53% (17/32)<0.001
One-Year Mortality2% (1/53)3% (3/89)13% (4/32)0.039
Receiver Operating Characteristic Area Under Curve (AUC)
AUC Timed Up-and-GoAUC Risk Calculator
COLORECTAL0.775 (95% CI: 0.670, 0.880)0.554 (95% CI: 0.499, 0.609)
CARDIAC0.684 (95% CI: 0.603, 0.766)0.552 (95% CI: 0.477, 0.626)

CONCLUSION(S): Slower walking speed forecasted an increased risk of postoperative complications and one-year mortality in a dose response fashion across surgical specialties. Regardless of operation performed, walking speed compared favorably the more complex standard-of-care risk calculators at forecasting postoperative morbidity.
Preoperative assessment utilizing walking speed in older adults is a paradigm shift from current strategies.


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