Key result
Slow preoperative Timed Up and Go linked to ~5-fold higher odds of major postoperative complications.
Why the study?
High postoperative morbidity after thoracolumbar spine surgery increases costs, necessitating identification of patients at risk of adverse outcomes.
Cohort (n=103)
No
Slow TUG performance was associated with higher complication risk after thoracolumbar surgery; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: Spine surgery rates have increased and the high postoperative morbidity in these patients result in increased costs. Consequently, it is essential to identify patients at risk of adverse outcomes. OBJECTIVE: To assess whether preoperative Timed Up and Go (TUG) test performance can predict high-grade postoperative complications. METHODS: A prospective cohort study of patients undergoing elective thoracolumbar spine surgery in a tertiary care hospital between 2017 and 2018. Patients were assessed preoperatively and assigned to the slow-TUG group if unable to perform or test performance time was ≥18.4 s. Primary outcome: high-grade postoperative complications. Secondary outcomes: overall complications, length of stay (LOS), discharge to healthcare facility, readmission and emergency department (ED) presentation. Patients were followed-up until 6 wk after surgery. RESULTS: One hundred three patients (mean age 62.95 ± 10.97 yr) were enrolled. Slow-TUG group were more likely to be classified as American Society of Anaesthesiology (ASA) class 3 (74.1% vs 47.4%, P = .02), non-independent (25.9% vs 5.3%, P < .01), and frail (92.3% vs 42.1%, P < .01). TUG was an independent predictor of high-grade complications (adjusted odds ratio (OR): 4.97, 95% CI: 1.18-22.47), overall complications (OR: 3.77, 95% CI: 1.33-11.81), discharge to a skilled-nursing facility (OR: 3.2, 95% CI: 1.00-10.70), readmission within 6 wk of surgery (OR: 9.14, 95% CI: 2.39-41.26) and LOS (adjusted incident rate ratio (IRR): 1.45, 95% CI: 1.16-1.80). CONCLUSION: Compared to traditional risk factors, TUG is an important predictor of adverse postoperative outcomes and may be used preoperatively to identify high-risk thoracolumbar surgery patients.
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Komodikis et al. (2019) conducted a cohort in Elective thoracolumbar spine surgery (n=103). Slow Timed Up and Go (TUG) test performance (≥18.4 s or unable to perform) vs. Normal TUG performance (<18.4 s) was evaluated on High-grade postoperative complications (adjusted OR: 4.97, 95% CI 1.18-22.47). Slow preoperative Timed Up and Go (TUG) test performance independently predicted a nearly 5-fold increased odds of high-grade postoperative complications (adjusted OR 4.97) in patients undergoing elective thoracolumbar spine surgery.
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