"Timed Up & Go": A Screening Tool for Predicting 30-Day Morbidity in Onco-Geriatric Surgical Patients? A Multicenter Cohort Study

Abstract

ObjectiveTo determine the predictive value of the “Timed Up & Go” (TUG), a validated assessment tool, on a prospective cohort study and to compare these findings to the ASA classification, an instrument commonly used for quantifying patients’ physical status and anesthetic risk.BackgroundIn the onco-geriatric surgical population it is important to identify patients at increased risk of adverse post-operative outcome to minimize the risk of over- and under-treatment and improve outcome in this population.Methods263 patients ≥70 years undergoing elective surgery for solid tumors were prospectively recruited. Primary endpoint was 30-day morbidity. Pre-operatively TUG was administered and ASA-classification was registered. Data were analyzed using multivariable logistic regression analyses to estimate odds ratios (OR) and 95% confidence intervals (95%-CI). Absolute risks and area under the receiver operating characteristic curves (AUC’s) were calculated.Results164 (62.4%) patients (median age: 76) underwent major surgery. 50 (19.5%) patients experienced major complications. 50.0% of patients with high TUG and 24.8% of patients with ASA≥3 experienced major complications (absolute risks). TUG and ASA were independent predictors of the occurrence of major complications (TUG:OR 3.43; 95%-CI = 1.13–10.36. ASA1 vs. 2:OR 5.67; 95%-CI = 0.86–37.32. ASA1 vs. 3&4:OR 11.75; 95%-CI = 1.62–85.11). AUCTUG was 0.66 (95%-CI = 0.57–0.75, p<0.001) and AUCASA was 0.58 (95%-CI = 0.49–0.67, p = 0.09).ConclusionsTwice as many onco-geriatric patients at risk of post-operative complications, who might benefit from pre-operative interventions, are identified using TUG than when using ASA.

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“…CGA studies have demonstrated the predictive value of these ADL/IADL tests with regard to survival, postoperative morbidity and mortality, and chemotherapy toxicity [13]. As an alternative to time-consuming evaluations, some very simple measures have been developed to evaluate functional performance, such as the ''Timed Up & Go'', which appears to be valuable for predicting postoperative complications after oncologic surgery [16]. Shortened forms of CGA have been proposed, although they require validation in routine clinical settings [17].…”

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“…The proportion of patients with low grip strength was higher than that seen in the Cardiovascular Health Study (20%) 28 , and average gait speed was slower than speeds measured for community-dwelling older adults in all but one study in a large systematic review 18 . Compared with other studies of older cancer patients, our study had a larger proportion of patients with low grip strength (50% vs. 21.4%) 32 and a higher proportion with a gait speed less than 1.0 m/s (91.7% vs. 54.4%) 32 , but a smaller proportion with a prolonged time on the tug test 7,[33][34][35][36][37][38] . Because gait speed was not reported in the latter studies, it is difficult to know whether average gait speed was slower in their patients than in ours.…”

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