An elderly person's walking speed can predict how well he or she will fare after an operation, according to new findings presented at the 2011 Annual Clinical Congress of the American College of Surgeons. Researchers from the University of Colorado, Denver, reported that a simple, walking test that typically takes less than 20 seconds was a powerful tool for predicting how well seniors would recover from various surgical procedures. They found that older individuals with a slower walking pace-a known indicator of frailty-had an increased risk of postoperative complications and disability.
More than half of all operations in the U.S. are performed on people 65 and older, according to the research team. With more operations being done on an aging population, accurate tools to define risk are more necessary than ever, according to Daniel Wu, MD, study co-author and chief surgical resident in the department of surgery at Denver Veteran''s Affairs Medical Center. "The bottom line is that we can no longer assess 80- year-olds in the same way as 25-year-olds."
The study included 195 patients age 65 and older undergoing cardiac or colorectal surgery. Preoperatively, investigators performed the timed-up-and-go test on all subjects. This walking test involves having a patient stand from a chair, walk 10 feet, then return to the chair and sit. Upon completing the test, patients are classified into one of three groups: fast, 10 seconds or less; intermediate, between 11 and 14 seconds; and slow, greater than or equal to 15 seconds.
For patients who underwent cardiac surgery, 73 percent of those whose walking speed was classified as slow were discharged to an institutional care facility. In contrast, only 17 percent of those whose walking pace was fast went into a care facility postoperatively. The slow group spent an average of two additional days in the hospital compared to the fast group. And, only 13 percent of the fast group, versus 37 percent of the slow group, experienced more than one postoperative complication.
For patients who had a colorectal operation, 59 percent of the slow group needed institutional care following their procedures while only 5 percent of the fast group required the same level of treatment. The slow group spent an average of eight more days in the hospital compared to the fast group. And, only 20 percent of patients in the fast group, versus 56 percent of those in the slow group, had more than one complication following their operations.
This research is a proof of concept study, explained study co-author Thomas Robinson, MD, FACS, associate professor of surgery. "Right now we are putting together a multi-institutional trial to confirm these results. 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."
Walking speed (gait speed) is a marker of physical frailty-a disabling condition characterized by muscle loss, exhaustion, and lack of physical resiliency. In that state, any additional stressor, such as an operation, could put a person in a dependent state, or worse, so gauging risk early on is important in helping seniors avoid adverse outcomes.
Some 80-year-olds are physiologically much younger or much older than others, and this walking speed test can distinquish between those two individuals, whereas standard preoperative assessments of the heart, lung, or kidney function cannot make that distinction, Dr. Robinson explained. "This approach may lead to a more individualized way of deciding who should undergo surgery. We are designing tests to get away from chronologic age, and instead are now focusing on physiologic age."
In future research, the authors plan to study other geriatric markers of frailty such as cognition, nutritional status, and grip strength. The goal, Dr Wu explained, is to create one comprehensive test that includes all of these markers and provides a scoring system that will better determine surgical risk in the elderly population.
"Our study showed that this timed-up-and-go test is a very sharp predictor of complications and mortality," Dr. Wu said. "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 study was supported by a grant from the National Institutes of Health.