Key result
A high pre-operative Timed Up & Go score (>20 seconds) independently predicted a more than three-fold increased risk of major 30-day post-operative complications in onco-geriatric surgical patients.
Why the study?
Does the pre-operative 'Timed Up & Go' (TUG) test predict 30-day morbidity better than the ASA classification in onco-geriatric surgical patients?
Cohort (n=263)
Yes
Does the pre-operative 'Timed Up & Go' (TUG) test predict 30-day morbidity better than the ASA classification in onco-geriatric surgical patients?
The Timed Up & Go test is a simple, effective pre-operative screening tool that identifies more onco-geriatric patients at risk for major post-operative complications than the standard ASA classification.
Answers are grounded in this paper and cite their sources.
TUG was associated with 30-day complications in onco-geriatric surgery; leaves open superiority to ASA and need for prospective validation.
OBJECTIVE: To determine the predictive value of the "Timed Up & Go" (TUG), a validated assessment tool, on a prospective cohort study and to compare these findings to the ASA classification, an instrument commonly used for quantifying patients' physical status and anesthetic risk. BACKGROUND: In the onco-geriatric surgical population it is important to identify patients at increased risk of adverse post-operative outcome to minimize the risk of over- and under-treatment and improve outcome in this population. METHODS: 280 patients ≥70 years undergoing elective surgery for solid tumors were prospectively recruited. Primary endpoint was 30-day morbidity. Pre-operatively TUG was administered and ASA-classification was registered. Data were analyzed using multivariable logistic regression analyses to estimate odds ratios (OR) and 95% confidence intervals (95%-CI). Absolute risks and area under the receiver operating characteristic curves (AUC's) were calculated. RESULTS: 180 (64.3%) patients (median age: 76) underwent major surgery. 55 (20.1%) patients experienced major complications. 50.0% of patients with high TUG and 25.6% of patients with ASA≥3 experienced major complications (absolute risks). TUG and ASA were independent predictors of the occurrence of major complications (TUG:OR 3.43; 95%-CI = 1.14-10.35. ASA1 vs. 2:OR 5.91; 95%-CI = 0.93-37.77. ASA1 vs. 3&4:OR 12.77; 95%-CI = 1.84-88.74). AUCTUG was 0.64 (95%-CI = 0.55-0.73, p = 0.001) and AUCASA was 0.59 (95%-CI = 0.51-0.67, p = 0.04). CONCLUSIONS: Twice as many onco-geriatric patients at risk of post-operative complications, who might benefit from pre-operative interventions, are identified using TUG than when using ASA.
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Huisman et al. (2014) conducted a cohort in Solid tumors requiring elective surgery (n=263). High Timed Up & Go (TUG) score (>20 seconds) vs. Normal TUG score (≤20 seconds) was evaluated on 30-day major morbidity (Clavien-Dindo grade 3-5) (OR 3.43, 95% CI 1.13-10.36, p=0.03). A high pre-operative Timed Up & Go score (>20 seconds) independently predicted a more than three-fold increased risk of major 30-day post-operative complications in onco-geriatric surgical patients.
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