Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Duke Clinical Research Institute, Durham, North Carolina.
JAMA Cardiol. 2016 Jun 1;1(3):314-21. doi: 10.1001/jamacardio.2016.0316.
Prediction of operative risk is a critical step in decision making for cardiac surgery. Existing risk models may be improved by integrating a measure of frailty, such as 5-m gait speed, to better capture the heterogeneity of the older adult population.
To determine the association of 5-m gait speed with operative mortality and morbidity in older adults undergoing cardiac surgery.
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted from July 1, 2011, to March 31, 2014, at 109 centers participating in the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The 5-m gait speed test was performed in 15 171 patients aged 60 years or older undergoing coronary artery bypass graft, aortic valve surgery, mitral valve surgery, or combined procedures.
All-cause mortality during the first 30 days after surgery; secondarily, a composite outcome of mortality or major morbidity during the index hospitalization.
Among the cohort of 15 171 patients undergoing cardiac surgery, the median age was 71 years and 4622 were female (30.5%). Compared with patients in the fastest gait speed tertile (>1.00 m/s), operative mortality was increased for those in the middle tertile (0.83-1.00 m/s; odds ratio [OR], 1.77; 95% CI, 1.34-2.34) and slowest tertile (<0.83 m/s; OR, 3.16; 95% CI, 2.31-4.33). After adjusting for the Society of Thoracic Surgeons predicted risk of mortality and the surgical procedure, gait speed remained independently predictive of operative mortality (OR, 1.11 per 0.1-m/s decrease in gait speed; 95% CI, 1.07-1.16). Gait speed was also predictive of the composite outcome of mortality or major morbidity (OR, 1.03 per 0.1-m/s decrease in gait speed; 95% CI, 1.00-1.05). Addition of gait speed to the Society of Thoracic Surgeons predicted risk resulted in a C statistic change of 0.005 and integrated discrimination improvement of 0.003.
Gait speed is an independent predictor of adverse outcomes after cardiac surgery, with each 0.1-m/s decrease conferring an 11% relative increase in mortality. Gait speed can be used to refine estimates of operative risk, to support decision-making and, since incremental value is modest when used as a sole criterion for frailty, to screen older adults who could benefit from further assessment.
心脏手术的决策制定的关键步骤是预测手术风险。通过整合诸如 5 米步行速度等脆弱性指标，可以改善现有的风险模型，以更好地捕捉老年人群的异质性。
确定 5 米步行速度与老年患者接受心脏手术后手术死亡率和发病率的相关性。
设计、地点和参与者：这是一项前瞻性队列研究，于 2011 年 7 月 1 日至 2014 年 3 月 31 日在参与胸外科医生学会成人心脏手术数据库的 109 个中心进行。在 15171 名年龄在 60 岁或以上接受冠状动脉旁路移植术、主动脉瓣手术、二尖瓣手术或联合手术的患者中进行了 5 米步行速度测试。
手术后 30 天内的全因死亡率；其次，指数住院期间死亡或主要发病率的复合结局。
在接受心脏手术的 15171 名队列患者中，中位年龄为 71 岁，4622 名女性（30.5%）。与最快步行速度三分位组（>1.00 m/s）相比，中速三分位组（0.83-1.00 m/s；优势比[OR]，1.77；95%置信区间[CI]，1.34-2.34）和最慢三分位组（<0.83 m/s；OR，3.16；95%CI，2.31-4.33）的手术死亡率更高。在调整胸外科医生学会预测的死亡率和手术程序后，步行速度仍然独立预测手术死亡率（每 0.1m/s 步行速度下降的 OR，1.11；95%CI，1.07-1.16）。步行速度也可预测死亡或主要发病率的复合结局（每 0.1m/s 步行速度下降的 OR，1.03；95%CI，1.00-1.05）。将步行速度加入胸外科医生学会预测的风险中，C 统计量的变化为 0.005，综合鉴别力的改善为 0.003。
步行速度是心脏手术后不良结局的独立预测因素，每下降 0.1m/s，死亡率相对增加 11%。步行速度可用于精确估计手术风险，为决策提供支持，并且由于作为脆弱性的唯一标准使用时增量价值适度，因此可以筛选出可能受益于进一步评估的老年人。
