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11-11-2010 | Cardiology | Article

Walking speed linked to adverse outcome risk after cardiac surgery

Abstract

Free abstract

MedWire News: Assessing the gait speed of elderly patients before cardiac surgery may help identify those with an increased risk for mortality and morbidity after cardiac surgery, study results suggest.

"This simple, rapid, and inexpensive test effectively stratifies patients beyond traditional estimates of risk, which tend to be inaccurate in the elderly," explain the study authors in the Journal of the American College of Cardiology.

Jonathan Afilalo (McGill University, Montreal, Quebec, Canada) and colleagues recruited 131 patients with a mean age of 75.8 years undergoing coronary artery bypass or valve replacement surgery.

All patients were timed while walking a distance of 5 meters, and classified as slow (n=60; walked 5 meters in ≥6 seconds) or normal walkers (n=71; walked 5 meters in <6 seconds).

In all, 30 patients died or experienced major morbidity, defined as stroke, renal failure, prolonged ventilation, infection, or re-operation, after surgery.

Afilalo and team found that patients with slow gait speed had a 3.17-fold increase in the risk for in-hospital postoperative mortality or major morbidity compared with those with normal gait speed.

Even after adjustment for each patient's Society of Thoracic Surgeons (STS) risk score, slow gait speed remained significantly associated with a 3.05-fold increased risk for postoperative mortality or major morbidity.

No correlation was found between STS score and gait speed.

This suggests that both factors independently predict adverse outcomes after surgery, say the researchers.

In an accompanying editorial, Joseph Cleveland (University of Colorado Health Sciences Center, Denver, USA) warned that in light of the ever increasing elderly population, "we must prepare ourselves to face decisions regarding treatment options for this exponentially growing segment of our population."

He commended Afilalo et al's efforts to identify an age-independent assessor of surgical risk among the elderly, as age "does not provide an accurate reflection of risk/benefit in selecting patients for cardiac surgery."

He advised however, that the use of gait speed as a risk assessment tool would serve best in conjunction with other existing tools, as "it would be inappropriate to conclude that a person is not a candidate for operation based solely on the 5-meter gait speed."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Lauretta Ihonor

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