The Predictive Ability of Timed ‘up & Go’ in Hepato-Pancreato-biliary Onco-Geriatric Surgical Patients : A Multi-Center Prospective Study

Aims: In the growing onco-geriatric surgical population, identifying patients at an increased risk for adverse outcome is crucial. Next to the severity of the surgical procedure, geriatric screening tools were found to predict the risk for major complications. The performance of these screening tools in patients undergoing major hepato-pancreato-biliary (HPB) surgery is unknown. The aim of this study was to analyze the predictive value of well-known screening tools regarding the risk for major postoperative complications in onco-geriatric surgical patients undergoing HPB-resective surgery. Methods: In an international cohort, patients >=70 years undergoing elective surgery for solid tumours were prospectively recruited. A subanalysis of HPB patients was performed. Primary endpoint was the incidence of major complications during the first 30 days after surgery. Preoperatively Timed Up and Go (TUG) was administered to assess mobility. ASA-classification, nutritional status (NS) and performance status (PS) were assessed as well. Results: Data of 58 HPB-patients with a mean age of 74 years (3 SD) were analyzed. Ten patients experienced major complications (18.2%). The vast majority of patients was diagnosed with stage 4 disease (n=48; 39.6%). The mean duration of anesthesia was five hours (2.7 SD). No statistical significant differences were found between patients with normal and with deranged results on the screening tools. Conclusions: Analysis didn't show a prognostic ability of TUG with respect to 30-day postoperative morbidity in our HPB subgroup. These results need to be carefully interpreted in light of the small number of patients. Furthermore, it is possible that the complexity of such surgery might play a role as the event of grade 3–4 complications and related mortality are more often unpredictable. Other studies with larger population are needed to validate these results and other screening tools could be considered for the preoperative assessment of oncogeriatric patients undergoing major surgery.