Summary
This prospective cohort study of 15,171 older adults (median age 71 years) undergoing cardiac surgery at 109 centres demonstrates that slower gait speed independently predicts operative mortality and morbidity, beyond existing risk stratification models. Patients in the slowest gait speed tertile (<0.83 m/s) had 3.16-fold increased odds of 30-day operative mortality compared to the fastest tertile (>1.00 m/s). The findings suggest that simple functional assessment via gait speed may enhance risk prediction for cardiac surgical candidates, though the absolute improvement to existing models was modest.
UK applicability
The findings are applicable to UK cardiac surgery practice, as gait speed testing is a low-cost, non-invasive assessment feasible in pre-operative evaluation. Implementation could support shared decision-making with older patients considering cardiac surgery, though adoption would require integration into existing UK pre-operative assessment pathways and validation in UK populations.
Key measures
5-metre gait speed (m/s); 30-day operative mortality; composite outcome of mortality or major morbidity; odds ratios with 95% confidence intervals; C statistic; integrated discrimination improvement
Outcomes reported
The study measured 30-day all-cause operative mortality and a composite outcome of mortality or major morbidity during index hospitalisation in older adults undergoing cardiac surgery. Gait speed was assessed via a 5-metre walk test and analysed for its association with surgical outcomes.
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