Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties
Open accessAbstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
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Frailty was measured using the Robinson Frailty Index.
“Frailty was measured using the Robinson Frailty Index.”
From Outcomes by frailty and mobility in older patients undergoing major urogynecologic surgery: a planned supplementary study of the apical suspension repair for vault prolapse in a three-arm randomized (ASPIRe) trial (2026) · cites this paper as [21]
The Discussion (page unavailable) says this study used the timed up-and-go test as a screening indicator for frailty, in place of a longer frailty assessment. Our copy does not identify a Robinson Frailty Index as the measure used; it describes a different test instead. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe study population had a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.
“The current study population had both a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.”
From Outcomes by frailty and mobility in older patients undergoing major urogynecologic surgery: a planned supplementary study of the apical suspension repair for vault prolapse in a three-arm randomized (ASPIRe) trial (2026) · cites this paper as [21]
The Methods describe a prospective cohort of older colorectal and cardiac surgery patients, and the Discussion treats timed up-and-go performance as an indicator of frailty. The paper therefore fits the cited example of a prospectively studied surgical population, but it does not report an overall frailty percentage or a comparison of composite frailty measures that would substantiate those parts of the sentence. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThis tool combined with the TUG test was found to predict postoperative complications better than standard risk-adjusted calculators across surgical specialties.
“This tool combined with the Timed Up and Go (TUG) test was found to predict postoperative complications better than standard risk-adjusted calculators across surgical specialties.20,21”
From Outcomes by frailty and mobility in older patients undergoing major urogynecologic surgery: a planned supplementary study of the apical suspension repair for vault prolapse in a three-arm randomized (ASPIRe) trial (2026) · cites this paper as [21]
The Results (page unavailable in our copy) report that TUG predicted postoperative complications better than the risk calculator in colorectal surgery and compared favorably with it in cardiac surgery. The Methods describe TUG and the calculator as separate predictors, not a tool combined with TUG. Thus, the paper does not establish that a combined tool outperformed calculators across surgical specialties. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThese prospective cohort studies were performed at Veteran's Administration hospitals in a predominantly male population.
“However, these prospective cohort studies were performed at Veteran’s Administration hospitals in a predominantly male population.”
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Sinai Abbreviated Geriatric Evaluation
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Preoperative Cognitive and Frailty Screening in the Geriatric Surgical Patient: A Narrative Review
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Timed up and go test and long-term survival in older adults after oncologic surgery
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Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection
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Gait speed and survival of older surgical patient with cancer: Prediction after machine learning
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Geriatría transversal. Un reto asistencial para el siglo xxi
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Pathways, Contributors, and Correlates of Functional Limitation Across Specialties: Workshop Summary
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Outcomes of Surgery for Stress Urinary Incontinence in the Older Woman
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Prehabilitation for Prevention of Postoperative Cognitive Dysfunction?
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A Call for Frailty Screening in the Preoperative Setting
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- Authors
- Robinson, T. N., Wu, D. S., Sauaia, A., Dunn, C. L., Stevens-Lapsley, J. E., Moss, M., Stiegmann, G. V., Gajdos, C., Cleveland, J. C., & Inouye, S. K.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Denver VA Medical Center (US)
- Corresponding author
- Robinson, Thomas N.
- Wu, Daniel S.
- Dunn, Christina L.
- Stiegmann, Greg V.
- Gajdos, Csaba
- Cleveland, Joseph C.
- Venue
- Annals of Surgery
- Published
- 2013-10
- Volume
- 258
- Issue
- 4
- Pages
- 582-590
- ISSN
- 0003-4932 (ISSN-L)
- PMC
- PMC3771691
- OpenAlex
- W2071643895
- Cited by
- 199
- References
- 43
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 10 · 2023: 13 · 2022: 12 · 2021: 13 · 2020: 30 · 2019: 22 · 2018: 19 · 2017: 22 · 2016: 19 · 2015: 16 · 2014: 13
- FWCI
- 7.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institute on Aging (K23AG034632, P01AG031720, NIA K23AG034632, NIH P01AG031720)
- National Heart, Lung, and Blood Institute (K24HL089223, NIH K24 HL089223)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- Timed Up and Go test, walking speed, postoperative complications, postoperative mortality, surgical risk prediction, colorectal surgery, cardiac surgery, older adults, functional capacity, preoperative assessment, surgical risk calculator, geriatric surgery, postoperative rehabilitation, postoperative delirium, postoperative pneumonia, postoperative thromboembolism, postoperative wound complications
- MeSH terms
- Aged, Aged, 80 and over, Decision Support Techniques, Female, Follow-Up Studies, Cardiac Surgical Procedures, Humans, Male, Postoperative Complications, Preoperative Care, Prognosis, Prospective Studies, Risk Factors, ROC Curve, Digestive System Surgical Procedures, Walking, Elective Surgical Procedures, Risk Assessment, Kaplan-Meier Estimate
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