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Objective The purpose of this study was to determine the relationship between the timed up-and-go test and postoperative morbidity and one-year mortality, and to compare the timed up-and-go to the standard-of-care surgical risk calculators for prediction of postoperative complications. Methods In this prospective cohort study, patients 65 years and older undergoing elective colorectal and cardiac operations with a minimum of one-year follow-up were included. The timed up-and-go test was performed preoperatively. This timed test starts with the subject standing from a chair, walking ten feet, returning to the chair, and ends after the subject sits. Timed up-and-go results were grouped: Fast≤10 sec, Intermediate=11-14 sec, Slow≥15 sec. Receiver operating characteristic curves were used to compare the three timed-up-and-go groups to current standard-of-care surgical risk calculators at forecasting postoperative complications. Results This study included 272 subjects (mean age of 74±6 years). Slower timed up-and-go was associated with an increased postoperative complications following colorectal (fast-13%, intermediate-29% and slow-77%;p<0.001) and cardiac (fast-11%, intermediate-26% and slow-52%;p<0.001) operations. Slower timed up-and-go was associated with increased one-year mortality following both colorectal (fast-3%, intermediate-10% and slow-31%;p=0.006) and cardiac (fast-2%, intermediate-3% and slow-12%;p=0.039) operations. Receiver operating characteristic area under curve of the timed up-and-go and the risk calculators for the colorectal group was 0.775 (95% CI:0.670,0.880) and 0.554 (95% CI:0.499,0.609), and for the cardiac group was 0.684 (95% CI:0.603,0.766) and 0.552 (95% CI:0.477,0.626). Conclusions Slower timed up-and-go forecasted increased postoperative complications and one-year mortality across surgical specialties. Regardless of operation performed, the timed up-and-go compared favorably to the more complex risk calculators at forecasting postoperative complications.

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The principal extrarenal manifestation of autosomal dominant polycystic kidney disease (ADPKD) involves formation of liver cysts derived from intrahepatic bile ducts. Autocrine and paracrine factors secreted into the cyst would be positioned to modulate the rate of hepatic cyst growth. The aim of this study was to identify potential growth factors present in human ADPKD liver cyst fluid. ducts and liver cysts originating from intrahepatic bile ducts, is characteristic of ADPKD.2-3 ADI'KD accounts for approximately 10% of endstage renal disease requiring hernodialysis or renal transplantation.* Present in more than 50% ofADPKD patients, hepatic cysts are the most common extrarenal manifestation and are a significant source of morbidity in ADPKD whose importance is likely to increase as treatments for renal manifestations progress. l . 5 ADPKD cysts begin as focal dilations that expand and detach from the original nephron or duct to form an autonomous, enclosed cyst. Expanding cysts displace the surrounding parenchyma. The principal clinical manifestation ofADPKD liver disease, cyst enlargement results in prominent abdominal distention, compression of surrounding organs, and impingement on vascular flow (Fig. 1). Elevated plasma levels of specific growth factors in ADPKD subjects suggests these factors drive errant cyst growth and expansion.6 Further, ADPKD renal cyst fluid contains a number of cytokines and growth factors,7?* and