Gait speed assessment as a prognostic tool for morbidity and mortality in vulnerable older adult patients following vascular surgery

Abstract

Introduction: Predicting the risk associated with vascular surgery in older adult patients has become increasingly challenging, primarily due to limitations in existing risk assessment tools. This study aimed to evaluate the utility of gait speed, a clinical indicator of frailty, in enhancing the prediction of mortality and morbidity in older adult patients undergoing vascular surgery.

Methods: A single-center prospective cohort study was conducted, involving older adult patients undergoing vascular surgery at four tertiary care hospitals between 2021 and 2022. Eligible patients were aged 80 years or older and scheduled for surgical treatment of peripheral arterial disease of the lower limbs (IIb Leriche-Le Fontaine). The primary factor of interest was gait speed, defined as taking more than 6 s to walk 5 meters. The primary outcomes were in-hospital postoperative mortality and major morbidity.

Results: The cohort comprised 131 patients with a mean age of 82.8 ± 1.4 years, with 34 % being female. Before vascular surgery, 60 patients (46 %) were categorized as slow walkers. Slow walkers were more likely to be female (43 % vs. 25 %, p < 0.03) and diabetic (50 % vs. 28 %, p < 0.01). Among the patients, 30 (23 %) experienced the primary composite outcome of mortality or major morbidity following vascular surgery. After adjusting for the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) Surgical Risk Calculator, slow gait speed independently predicted the composite outcome (odds ratio: 3.05; 95 % confidence interval: 1.23 to 7.54).

Conclusions: Gait speed is a straightforward and effective test that can help identify a subgroup of frail older adult patients at an elevated and incremental risk of mortality and major morbidity after vascular surgery. While gait speed remains a valuable clinical indicator of frailty, it is important to recognize that the broader context of mobility plays a pivotal role in postoperative outcomes.

Keywords: Gait speed; Morbidity; Mortality; Vascular surgery.