Slow gait speed is associated with worse postoperative outcomes in cardiac surgery: A systematic review and meta‐analysis

Abstract

Background Frailty is associated with poorer outcomes in cardiac surgery, but the heterogeneity in frailty assessment tools makes it difficult to ascertain its true impact in cardiac surgery. Slow gait speed is a simple, validated, and reliable marker of frailty. We performed a systematic review and meta‐analysis to examine the effect of slow gait speed on postoperative cardiac surgical patients. Methods PubMED, MEDLINE, and EMBASE databases were searched from January 2000 to August 2021 for studies comparing slow gait speed and “normal” gait speed. Primary outcome was in‐hospital mortality. Secondary outcomes were composite mortality and major morbidity, AKI, stroke, deep sternal wound infection, prolonged ventilation, discharge to a healthcare facility, and ICU length of stay. Results There were seven eligible studies with 36,697 patients. Slow gait speed was associated with increased likelihood of in‐hospital mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]: 1.87–2.87). Additionally, they were more likely to suffer from composite mortality and major morbidity (RR: 1.52; 95% CI: 1.38–1.66), AKI (RR: 2.81; 95% CI: 1.44–5.49), deep sternal wound infection (RR: 1.77; 95% CI: 1.59–1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48–2.63), reoperation (RR: 1.38; 95% CI: 1.05–1.82), institutional discharge (RR: 2.08; 95% CI: 1.61–2.69), and longer ICU length of stay (MD: 21.69; 95% CI: 17.32–26.05). Conclusion Slow gait speed is associated with poorer outcomes in cardiac surgery. Frail patients are twofold more likely to die during hospital admission than nonfrail counterparts and are at an increased risk of developing various perioperative complications.

Using Outcome Measures to Transition Ambulation From Physical Therapy to Nursing for Patients With Mechanical Circulatory Support

“…Other studies29-31 have suggested that slower gait speed cutoff scores (<0.8 m/s) put patients at higher risk for frailty, hospitalization, mortality, and poor outcomes. While this study had a slower Gait Speed cutoff (≥0.57 m/s), this could be due to a more acute critical condition, use of a self-selected gait speed, and/or the logistics of managing lines and tubes, as well as the number of support personnel required to ensure safety.…”

“…There is limited evidence about the use of a cutoff score when transitioning ambulation from physical therapy to nursing service. Cutoff scores from certain outcome measures have been used to suggest patient discharge location [26][27][28] and risk of frailty, rehospitalization, mortality, and morbidity, [29][30][31] but never to support the transition of mobility responsibility while patients are still admitted in an acute care setting. The primary aim of this study is to explore the feasibility of using cutoff scores for AM-PAC, Perme, and gait speed to determine when it is most appropriate to transition ambulation from physical therapy service to nursing service.…”

Multimodal prehabilitation for major surgery in elderly patients to lower complications: protocol of a randomised, prospective, multicentre, multidisciplinary trial (PREHABIL Trial)

“…22 Despite the inconsistency of the definition of frailty, it can be assessed using a variety of tools such as the clinical frailty scale or more objective Fried frailty criteria including gait speed and handgrip strength, which are useful predictors of all-cause mortality and cardiovascular disease and death in elderly surgical and non-surgical patients. [23][24][25] Similarly, standardised screening and assessments exist for the diagnosis of malnutrition and sarcopenia, which demonstrated significant overlap with frailty. [26][27][28] In summary, the elderly, frail, malnourished and sarcopenic patient is especially at risk for perioperative complications, however, many options for medical, physiological and psychological optimisation exist.…”

“…All these factors contribute to a reduction in functional capacity 22. Despite the inconsistency of the definition of frailty, it can be assessed using a variety of tools such as the clinical frailty scale or more objective Fried frailty criteria including gait speed and handgrip strength, which are useful predictors of all-cause mortality and cardiovascular disease and death in elderly surgical and non-surgical patients 23–25. Similarly, standardised screening and assessments exist for the diagnosis of malnutrition and sarcopenia, which demonstrated significant overlap with frailty 26–28.…”

Frailty-Diagnostik in verschiedenen AINS-Settings

“…Ersten Studien zufolge ist die Testung von Frailty auf Grundlage der Gehgeschwindigkeit ein geeignetes Scree-ning-Tool [28]. Die Diagnostik von präoperativer Frailty mit einer Gehgeschwindigkeit von < 0,83 m/s konnte bei herzchirurgischen Eingriffen eine Verdopplung der Krankenhausmortalität und ein signifikant erhöhtes Risiko für Infektionen, akutes Nierenversagen, Intensivstationsaufenthalten sowie weitere Adverse Events nachweisen [30]. In einer anderen Studie wurden für die Gehgeschwindigkeit eine Sensitivität von 99 % und Spezifität von 64 % für das Vorliegen einer Frailty angegeben [28].…”