By Christina Frangou
San Francisco—An elderly person’s walking speed can predict how well he or she will fare after an operation, according to a report at the 2011 Annual Clinical Congress of the American College of Surgeons (ACS).Researchers from the University of Colorado, Denver, reported that a simple walking test performed before surgery is a powerful tool for determining the extent to which seniors will recover after cardiac or colorectal procedures.
“Our study showed that this timed up-and-go test is a very sharp predictor of complications and mortality,” said Daniel Wu, MD, study co-author and chief surgical resident, Denver Veteran’s Affairs Medical Center, in Colorado, in a press release from the ACS. “It’s a cheap and simple test that may eventually lead to a change in preoperative care. You really only need a stop watch to perform this test, and the implications are huge.”
The findings stem from a study of 195 patients aged 65 and older who were scheduled for heart or colorectal surgery. Before surgery, the researchers gave the patients a short, timed walking test. Patients were asked to stand up from a chair, walk 10 feet, turn around, return to the chair and sit down. After completing the test, the patients were classified as fast (≤ 10 seconds), intermediate (11-14 seconds) or slow (≥ 15 seconds).
Results showed that slower walking speed was associated with increased risk for complications, longer length of stay and higher rates of discharge after both cardiac and colorectal procedures. Among the 65 colorectal patients, the patients classified as slow spent more than twice as many days in the hospital as fast patients (14.4±12.4 vs. 6.3±4.1 days; P=0.009), and they were 10 times more likely to be discharged to an institution rather than home (59% vs. 5%; P=0.007). These patients also had significantly higher rates of complications (56% vs. 20%; P=0.0424). Similar differences were shown in patients undergoing cardiac procedures.
Walking speed is a good marker of physical frailty, said investigators. A walking speed test may distinguish physiologically weak patients in a way that preoperative assessments of heart, lung or kidney function might not.The simple walking test is a useful tool that surgeons now can add to their preoperative evaluations of geriatric patients, said Emily Finlayson, MD, assistant professor of surgery, University of California, San Francisco. “It’s something that can be done fairly easily in the clinic. It just takes a minute, and this one simple measure really has a powerful ability to tell us whether patients are going to have complications, whether they are going to have prolonged hospital stays and where they are going to be going after surgery,” she said. Many of the other tests for frailty are cumbersome, she said. This one is not, and the results, although early, are compelling.
“With this, we can have really informed discussions with our patients about what the expected outcomes are after their operations and also help with planning afterward. For instance, if you are somebody who is going to require acute rehabilitation after surgery, you can start organizing that even before surgery.”
Study co-author Thomas Robinson, MD, associate professor of surgery, University of Colorado, Boulder, said he hopes this approach could lead to a more individualized way of deciding who should undergo surgery.“We are designing tests to get away from chronological age, and instead are now focusing on physiologic age,” Dr. Robinson said. “Ultimately, what we are trying to do is establish very simple tools that the average surgeon can use to determine who is going to fare poorly after an operation.”
The research is a proof-of-concept study, and more work is needed to develop an accurate tool for assessing geriatric patients, he added. The investigators are currently organizing a multi-institution trial to confirm the results.