"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: 263 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: 164 (62.4%) patients (median age: 76) underwent major surgery. 50 (19.5%) patients experienced major complications. 50.0% of patients with high TUG and 24.8% 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 = 1.13–10.36. ASA1 vs. 2:OR 5.67; 95%-CI = 0.86–37.32. ASA1 vs. 3&4:OR 11.75; 95%-CI = 1.62–85.11). AUC(TUG) was 0.66 (95%-CI = 0.57–0.75, p<0.001) and AUC(ASA) was 0.58 (95%-CI = 0.49–0.67, p = 0.09). 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.