"Timed Up & Go": a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study.
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.
Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Monique G
MG
Huisman
Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Barbara L
BL
van Leeuwen
Department of Surgery, S. Orsola Malphighi Hospital, Bologna, Italy.
Giampaolo
G
Ugolini
Department of Surgery, S. Orsola Malphighi Hospital, Bologna, Italy.
Isacco
I
Montroni
Department of Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; Regional University Hospital of Patras, Patras, Greece.
John
J
Spiliotis
Department of Surgery, San Martino University Hospital, Genua, Italy.
Cesare
C
Stabilini
Department of Surgery, North Manchester General Hospital, Manchester, United Kingdom.
Nicola
N
de'Liguori Carino
Department of Surgery, S. Maria Hospital, Perugia, Italy ; Luton & Dunstable Hospital, Luton, United Kingdom.
Eriberto
E
Farinella
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Geertruida H
GH
de Bock
Department of Surgery, University of Liverpool St. Helens Teaching Hospital, St. Helens, United Kingdom.
Riccardo A
RA
Audisio
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis