*Department of Surgery †School of Public Health ‡Department of Physical Medicine and Rehabilitation Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO §Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and Institute for Aging Research, Hebrew SeniorLife, Boston, MA ¶Department of Surgery, Denver Veteran Affairs Medical Center, Denver, CO.
Ann Surg. 2013 Oct;258(4):582-8; discussion 588-90. doi: 10.1097/SLA.0b013e3182a4e96c.
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.
本研究旨在确定计时起立行走测试（Timed Up and Go test）与术后发病率和 1 年死亡率之间的关系，并比较计时起立行走测试与标准护理手术风险计算器在预测术后并发症方面的效果。
这是一项前瞻性队列研究，纳入了接受择期结直肠和心脏手术且至少随访 1 年的 65 岁及以上患者。在术前进行计时起立行走测试。该计时测试从患者从椅子上站起来、走 10 英尺、回到椅子上开始，直到患者坐下结束。计时起立行走测试的结果分为快（≤10 秒）、中（=11-14 秒）和慢（≥15 秒）三组。使用受试者工作特征曲线比较三组计时起立行走测试结果与当前标准护理手术风险计算器在预测术后并发症方面的效果。
本研究纳入了 272 名患者（平均年龄 74±6 岁）。在结直肠（快组 13%，中组 29%，慢组 77%；P<0.001）和心脏（快组 11%，中组 26%，慢组 52%；P<0.001）手术后，计时起立行走测试越慢，术后并发症发生率越高。在结直肠（快组 3%，中组 10%，慢组 31%；P=0.006）和心脏（快组 2%，中组 3%，慢组 12%；P=0.039）手术后，计时起立行走测试越慢，1 年死亡率越高。结直肠组的计时起立行走测试和风险计算器的受试者工作特征曲线下面积分别为 0.775（95%CI：0.670-0.880）和 0.554（95%CI：0.499-0.609），心脏组分别为 0.684（95%CI：0.603-0.766）和 0.552（95%CI：0.477-0.626）。
计时起立行走测试越慢，预示着外科手术的术后并发症和 1 年死亡率越高。无论手术类型如何，计时起立行走测试在预测术后并发症方面的效果均优于更为复杂的风险计算器。
