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Gait Speed as a Vital Sign: Is There a Relationship with Esophageal Anastomotic Leak?
Justin S. Heidel1, Fatemehsadat Pezeshkian1, Anupama Singh1, Jose Agustin Rodriguez Zamboni1, Andes Wong2, Laura Frain3, Jon Wee1, Matthew J. Pommerening1, Michael T. Jaklitsch1, Desiree Steimer1 1Division of Thoracic Surgery, Mass General Brigham, Boston, MA 2Harvard Medical School, Boston, MA 3Division of Aging, Mass General Brigham, Boston, MA
Background: Gait speed is an objective measure of frailty and impaired physiologic reserve and has been shown to be a predictor of poor outcomes after lung resection. Its association with anastomotic leak after esophagectomy is unexplored. Methods: Prospectively maintained, single-institution database of patients who underwent esophagectomy (2021-2025). Four-meter gait speed (4MGS) was dichotomized as “frail” (<0.8 m/s) and “fit” (≥0.8 m/s). A multivariable Firth penalized regression was constructed to evaluate its effect on anastomotic leak. 4MGS predictive ability was evaluated by receiver-operator characteristic curves adjusted for surgical subtype, albumin, comorbidities, and neoadjuvant therapy. Optimism correction was performed with bootstrapping internal validation. Results: A total of 164 patients were included. 4MGS identified 20 patients as frail (12.2%) and 144 patients as fit (87.8%). Frail 4MGS cohort had higher rates of anastomotic leak (30.0%, n=6 vs. 12.5%, n=18, p=0.038). Decreasing 4MGS by 0.1 m/s was independently associated with anastomotic leak (adjusted OR: 1.22 (95%CI: 1.00-1.51), p=0.050). Adding 4MGS to a clinical model modestly improved AUC (Δ0.03, 0.67 [95%CI: 0.55-0.79] vs. 0.70 [95%CI: 0.58-0.81], p-value 0.5). This difference persisted after optimism-correction. Conclusion: 4MGS is independently associated with anastomotic leak after esophagectomy. This easily measured parameter complements preoperative clinical factors and may identify patients who benefit from prehabilitation.
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