New utility for an old tool: can a simple gait speed test predict ambulatory surgical discharge outcomes?
OBJECTIVE
The primary aims of this study were to design prediction models based on a functional marker (preoperative gait speed) to predict readiness for home discharge time of 90 mins or less and to identify those at risk for unplanned admissions after elective ambulatory surgery.


METHODS
This prospective observational cohort study evaluated all patients scheduled for elective ambulatory surgery. Home discharge readiness and unplanned admissions were the primary outcomes. Independent variables included preoperative gait speed, heart rate, and total anesthesia time. The relationship between all predictors and each primary outcome was determined in separate multivariable logistic regression models.


RESULTS
After adjustment for covariates, gait speed with adjusted odds ratio of 3.71 (95% confidence interval, 1.21-11.26), P = 0.02, was independently associated with early home discharge readiness of 90 mins or less. Importantly, gait speed dichotomized as greater or less than 1 m/sec predicted unplanned admissions, with odds ratio of 0.35 (95% confidence interval, 0.16-0.76, P = 0.008) for those with speeds 1 m/sec or greater in comparison with those with speeds less than 1 m/sec. In a separate model, history of cardiac surgery with adjusted odds ratio of 7.5 (95% confidence interval, 2.34-24.41; P = 0.001) was independently associated with unplanned admissions after elective ambulatory surgery, when other covariates were held constant.


CONCLUSIONS
This study demonstrates the use of novel prediction models based on gait speed testing to predict early home discharge and to identify those patients at risk for unplanned admissions after elective ambulatory surgery.
From the Yale University School of Medicine, New Haven, Connecticut (CAO, RBS, KHS, DGS, PGB); and Yale School of Public Health, New Haven, Connecticut (FD).
Charles A
CA
Odonkor
Robert B
RB
Schonberger
Feng
F
Dai
Kirk H
KH
Shelley
David G
DG
Silverman
Paul G
PG
Barash
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D001794:Blood Pressure / Q000502:physiology; D013504:Cardiovascular Surgical Procedures; D015897:Comorbidity; D005260:Female; D005684:Gait / Q000502:physiology*; D006331:Heart Diseases / Q000453:epidemiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge; D057234:Preoperative Period; D011446:Prospective Studies; D055815:Young Adult