Cai Ping-Ping, Gu Lu-Lu, Wang Xin, Wu Cui-Li, Ye Xiang-Hong, Zhang Kang-Zhen
Jinling Hospital Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Affiliated Wuxi Fifth Hospital of Jiangnan University, The Fifth People's Hospital of Wuxi, Wuxi, China.
Braz J Med Biol Res. 2025 Jan 31;58:e14103. doi: 10.1590/1414-431X2024e14103. eCollection 2025.
Frailty is a significant risk factor for adverse outcomes in elderly surgical patients. Gait speed assessment is a new tool recently used to stratify risk for these pre-operative adverse outcomes. In this prospective study of 392 frail elderly patients undergoing abdominal surgery, we investigated the predictive value of preoperative gait speed for postoperative outcomes. Patients were divided into two groups based on their 6-meter gait speed: normal (≥0.8 m/s, n=184) and slow (<0.8 m/s, n=208). The slow group was older, had more comorbidities, and higher American Society of Anesthesiologists (ASA) grades (P<0.05). They also had significantly higher rates of 30-day overall complications (38.9 vs 18.5%, P<0.01), severe complications (12.0 vs 4.3%, P<0.01), and 1-year mortality (15.4 vs 6.5%, P=0.008) compared to the normal group. Pulmonary infection, wound infection, and delirium were the most common complications. Multivariate logistic regression confirmed slow gait speed as an independent risk factor for 30-day complications (OR=2.38, 95%CI: 1.41-4.01) and 1-year mortality (OR=2.19, 95%CI: 1.07-4.48). Our findings demonstrated that preoperative 6-meter gait speed effectively predicted short-term complications and mid-term mortality in frail elderly patients undergoing abdominal surgery. This suggests the need for individualized perioperative management strategies for high-risk patients with slow gait speed to potentially improve their prognosis.
衰弱是老年外科患者出现不良结局的一个重要风险因素。步态速度评估是最近用于对这些术前不良结局进行风险分层的一种新工具。在这项对392例接受腹部手术的衰弱老年患者的前瞻性研究中，我们调查了术前步态速度对术后结局的预测价值。根据患者的6米步态速度将其分为两组：正常组（≥0.8米/秒，n = 184）和缓慢组（<0.8米/秒，n = 208）。缓慢组年龄更大，合并症更多，美国麻醉医师协会（ASA）分级更高（P<0.05）。与正常组相比，他们的30天总体并发症发生率（38.9%对18.5%，P<0.01）、严重并发症发生率（12.0%对4.3%，P<0.01）和1年死亡率（15.4%对6.5%，P = 0.008）也显著更高。肺部感染、伤口感染和谵妄是最常见的并发症。多因素逻辑回归证实步态速度缓慢是30天并发症（OR = 2.38，95%CI：1.41 - 4.01）和1年死亡率（OR = 2.19，95%CI：1.07 - 4.48）的独立风险因素。我们的研究结果表明，术前6米步态速度能有效预测接受腹部手术的衰弱老年患者的短期并发症和中期死亡率。这表明需要针对步态速度缓慢的高危患者制定个体化的围手术期管理策略，以潜在地改善他们的预后。
