Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery.
OBJECTIVE
The purpose of this study was to test the value of gait speed, a clinical marker for frailty, to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery.


BACKGROUND
It is increasingly difficult to predict the elderly patient's risk posed by cardiac surgery because existing risk assessment tools are incomplete.


METHODS
A multicenter prospective cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009. Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and/or valve replacement or repair. The primary predictor was slow gait speed, defined as a time taken to walk 5 m of ≥ 6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity.


RESULTS
The cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years; 34% were female patients. Sixty patients (46%) were classified as slow walkers before cardiac surgery. Slow walkers were more likely to be female (43% vs. 25%, p = 0.03) and diabetic (50% vs. 28%, p = 0.01). Thirty patients (23%) experienced the primary composite end point of mortality or major morbidity after cardiac surgery. Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score (odds ratio: 3.05; 95% confidence interval: 1.23 to 7.54).


CONCLUSIONS
Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery.
Division of Cardiology, Department of Medicine, SMBD-Jewish General Hospital, McGill University, Montreal, Quebec, Canada. jonathan@afilalo.com
Jonathan
J
Afilalo
Mark J
MJ
Eisenberg
Jean-François
JF
Morin
Howard
H
Bergman
Johanne
J
Monette
Nicolas
N
Noiseux
Louis P
LP
Perrault
Karen P
KP
Alexander
Yves
Y
Langlois
Nandini
N
Dendukuri
Patrick
P
Chamoun
Georges
G
Kasparian
Sophie
S
Robichaud
S Michael
SM
Gharacholou
Jean-François
JF
Boivin
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D016001:Confidence Intervals; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006331:Heart Diseases / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology