Use of the Frailty "timed up and go" Test to Predict Perioperative Complications in Patients Undergoing Gynecologic Cancer Surgery.

Abstract

Study objective: To assess the predictive value of frailty measured by the timed up and go (TUG) test on perioperative outcomes versus other perioperative screening methods.

Design: Retrospective cohort study SETTING: Duke University Hospital and Duke Raleigh Hospital PATIENTS: Patients who underwent surgery with gynecologic oncologists at our institution from October 2019 to October 2023 with a preoperative TUG time recorded were included.

Intervention(s): TUG times were recorded preoperatively. TUG time >12 seconds was considered frail. American Society of Anesthesiologists scores were extracted from the medical record. Modified frailty index (mFI) was calculated using 11 variables extracted from the medical record.

Measurements and main results: Outcomes included postoperative complications, length of stay, and postoperative disposition. Comparisons between TUG times dichotomized at 8 and 12 seconds were made using Wilcoxon rank sum or chi-square; logistic regression was used to predict TUG time using these dichotomizations. Overall, 174 patients were included; 39 (22.4%) underwent laparotomy, 123 (70.6%) underwent laparoscopy, and 12 (6.9%) underwent other minor surgeries. Frail patients (TUG time > 12 seconds) were older and had higher mFI scores and lower preoperative albumin than nonfrail patients. There were no differences in major or minor complication rates after laparoscopic surgery between frail and nonfrail patients. American Society of Anesthesiologists and mFI were not associated with the need for transfusion (p > .05). Frail patients were more likely to receive a perioperative blood transfusion compared to nonfrail patients in the overall cohort (19.2% vs 4.1%, p = .0034). TUG time did not predict length of stay or postoperative disposition.

Conclusion: Slower TUG times were associated with comorbidities, older age, and malnutrition. Frailty was not associated with complications in those who underwent laparoscopic surgery. Our findings support the use of this easy-to-administer practical frailty screening tool compared to more traditional methods.