Dataset Information

Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties.

ABSTRACT: 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.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.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).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.

SUBMITTER: Robinson TN

PROVIDER: S-EPMC3771691 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties.

Robinson Thomas N TN Wu Daniel S DS Sauaia Angela A Dunn Christina L CL Stevens-Lapsley Jennifer E JE Moss Marc M Stiegmann Greg V GV Gajdos Csaba C Cleveland Joseph C JC Inouye Sharon K SK

Annals of surgery 20131001 4

<h4>Objective</h4>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.<h4>Methods</h4>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 w ...[more]

PMID: 23979272

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Project description:ImportanceFrailty is an important risk factor for postoperative mortality. Whether the association between frailty and mortality is consistent across all surgical specialties, especially those predominantly performing lower stress procedures, remains unknown.ObjectiveTo examine the association between frailty and postoperative mortality across surgical specialties.Design, setting, and participantsA cohort study was conducted across 9 noncardiac specialties in hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and Veterans Affairs Surgical Quality Improvement Program (VASQIP) from January 1, 2010, through December 31, 2014, using multivariable logistic regression to evaluate the association between frailty and postoperative mortality. Data analysis was conducted from September 15, 2019, to April 30, 2020. Patients 18 years or older undergoing noncardiac procedures were included.ExposuresRisk Analysis Index measuring preoperative frailty categorized patients as robust (Risk Analysis Index ≤20), normal (21-29), frail (30-39), or very frail (≥40). Operative Stress Score (OSS) categorized procedures as low (1-2), moderate (3), and high (4-5) stress. Specialties were categorized by case-mix as predominantly low intensity (>75% OSS 1-2), moderate intensity (50%-75%), or high intensity (<50%).Main outcomes and measuresThirty-day (both measures) and 180-day (VASQIP only) postoperative mortality.ResultsOf the patients evaluated in NSQIP (n = 2 339 031), 1 309 795 were women (56.0%) and mean (SD) age was 56.49 (16.4) years. Of the patients evaluated in VASQIP (n = 426 578), 395 761 (92.78%) were men and mean (SD) age was 61.1 (12.9) years. Overall, 30-day mortality was 1.2% in NSQIP and 1.0% in VASQIP, and 180-day mortality in VASQIP was 3.4%. Frailty and OSS distributions differed substantially across the 9 specialties. Patterns of 30-day mortality for frail and very frail patients were similar in NSQIP and VASQIP for low-, moderate-, and high-intensity specialties. Frailty was a consistent, independent risk factor for 30- and 180-day mortality across all specialties. For example, in NSQIP, for plastic surgery, a low-intensity specialty, the odds of 30-day mortality in very frail (adjusted odds ratio [aOR], 27.99; 95% CI, 14.67-53.39) and frail (aOR, 5.1; 95% CI, 3.03-8.58) patients were statistically significantly higher than for normal patients. This was also true in neurosurgery, a moderate-intensity specialty, for very frail (aOR, 9.8; 95% CI, 7.68-12.50) and frail (aOR, 4.18; 95% CI, 3.58-4.89) patients and in vascular surgery, a high-intensity specialty, for very frail (aOR, 10.85; 95% CI, 9.83-11.96) and frail (aOR, 3.42; 95% CI, 3.19-3.67) patients.Conclusions and relevanceIn this study, frailty was associated with postoperative mortality across all noncardiac surgical specialties regardless of case-mix. Preoperative frailty assessment could be implemented across all specialties to facilitate risk stratification and shared decision-making.

Project description:BackgroundMaintaining both walking speed and cognitive function is essential for active, healthy aging. This study investigated age-related differences in walking speed and global cognitive function with aging and the association between them among older adults residing in the developing country of China.MethodsThis cross-sectional study measured usual (UWS) and maximal walking speed (MWS) of participants for six meters. The Chinese version of the Montreal Cognitive Assessment was used to evaluate global cognition through in-person interviews. Analyses of variance were used to compare the differences in UWS, MWS, and global cognition between genders and age groups. Multiple linear regression models were used to determine the association between walking speed and global cognitive function.ResultsIn total, 791 Chinese adults (252 men and 539 women) aged 60-89 years were included in this study. Markedly slowed UWS and worse global cognitive function scores were observed for both genders among adults ≥80 years of age. MWS slowed considerably in men ≥85 years of age and in women ≥80 years of age. There was a significant gender difference in MWS-with men walking faster than women-but not in UWS. Linear regression analysis adjusted for the confounding factors of gender, height, weight, years of education, and chronic disease indicated that MWS, but not UWS, was significantly associated with global cognitive function (β = 0.086, [0.177, 1.657], P = 0.015) such that slower maximal walking speed was associated with poorer cognitive performance. This association was statistically significant only for adults aged 75-79 years (β = 0.261 [0.647, 4.592], P = 0.010).ConclusionWalking speed was slower in the older age groups. Global cognitive function deteriorated markedly after 80 years of age. After controlling for confounding variables, slower MWS, but not UWS, was associated with poorer global cognitive function. MWS may serve as a potential indicator for earlier identification of poor cognition and motoric cognitive risk syndrome in an older Chinese population.

Project description:BackgroundSarcopenia might function as an indicator for frailty, and as such as a risk factor for the development of postoperative complications. The aim of this study was to meta-analyse the relation between preoperative sarcopenia and the development of severe postoperative complications in patients undergoing oncological surgery.MethodsPubMed and Embase databases were systematically searched from inception until May 2018. Included were studies reporting on the incidence of severe postoperative complications and radiologically determined preoperative sarcopenia. Studies reporting the skeletal muscle as a continuous variable only were excluded. Data were extracted independently by two reviewers. Random effect meta-analyses were applied to estimate the pooled odds ratio (OR) with 95% confidence intervals (95% CI) for severe postoperative complications, defined as Clavien-Dindo grade ≥3, including 30-day mortality. Heterogeneity was evaluated with I2 testing. Analyses were performed overall and stratified by measurement method, tumour location and publication date.ResultsA total of 1924 citations were identified, and 53 studies (14 295 patients) were included in the meta-analysis. When measuring the total skeletal muscle area, 43% of the patients were sarcopenic, versus 33% when measuring the psoas area. Severe postoperative complications were present in 20%, and 30-day mortality was 3%. Preoperative sarcopenia was associated with an increased risk of severe postoperative complications (ORpooled : 1.44, 95% CI: 1.24-16.8, P<0.001, I2 =55%) and 30-day mortality (ORpooled : 2.15, 95% CI: 1.46-3.17, P<0.001, I2 =14%). A low psoas mass was a stronger predictor for severe postoperative complications compared with a low total skeletal muscle mass (ORpooled : 2.06, 95% CI: 1.37-3.09, ORpooled : 1.32, 95% CI: 1.14-1.53, respectively) and 30-day mortality [ORpooled : 6.17 (95% CI: 2.71-14.08, ORpooled : 1.80 (95% CI: 1.24-2.62), respectively]. The effect was independent of tumour location and publication date.ConclusionsThe presence of low psoas mass prior to surgery, as an indicator for sarcopenia, is a common phenomenon and is a strong predictor for the development of postoperative complications. The presence of low total skeletal muscle mass, which is even more frequent, is a less informative predictor for postoperative complications and 30-day mortality. The low heterogeneity indicates that the finding is consistent over studies. Nevertheless, the value of sarcopenia relative to other assessments such as frailty screening is not clear. Research is needed in order to determine the place of sarcopenia in future preoperative risk stratification.

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Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties.

Publications

Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties.

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