{ "abstract": "Introduction Poor cardiopulmonary fitness is an important risk factor for postoperative complications, yet a feasible, objective and prognostically accurate method to assess preoperative fitness has not been established. The 6 min walk test (6MWT) is a simple, inexpensive and widely applicable measure that shows promise for predicting postoperative risk. However, robust data are lacking on whether the 6MWT accurately predicts complications, provides incremental prognostic value beyond routinely collected clinical factors or outperforms simpler alternatives such as questionnaires, cardiac biomarkers or grip strength testing. The Functional Assessment for Surgery by a Timed Walk (FAST Walk) study is designed to address these knowledge gaps by evaluating whether the 6MWT improves prediction of key postoperative outcomes compared with clinical factors and simpler measures of fitness.Methods and analysis The FAST Walk study is an international multicentre prospective cohort study of 1672 adults (≥40 years) undergoing major elective non-cardiac surgery at centres in Canada, Hong Kong, Australia, Spain and the Netherlands. Participants complete a preoperative 6MWT and baseline assessments of comorbidities, self-reported cardiopulmonary fitness (MET: Re-evaluation for Perioperative Cardiac Risk questionnaire), biomarkers (N-terminal pro-B-type natriuretic peptide) and grip strength. The primary outcome is 30-day death or major postoperative complication, defined as Clavien-Dindo grade II or higher. Secondary outcomes are (1) death or new significant disability at 90 days after surgery and (2) days alive and out of hospital at 30 days after surgery. Disability is measured using the short-form WHO Disability Assessment Schedule 2.0 instrument. Multivariable regression models and complementary metrics of prediction performance will be used to determine whether 6MWT distance adds prognostic value beyond routinely collected clinical factors and simpler measures of fitness.Ethics and dissemination The FAST Walk study has received research ethics board approval at all participating sites. Recruitment commenced in June 2024, with completion of participant follow-up expected in 2026. Findings will be disseminated through peer-reviewed publications and conference presentations, with the primary results anticipated in 2027.Trial registration number NCT06412367.", "authors": [ { "affiliations": [ "Department of Anesthesia, St Michael’s Hospital, Toronto, Ontario, Canada", "Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada", "Applied Health Research Centre, Unity Health Toronto, Toronto, Ontario, Canada" ], "name": "Duminda N Wijeysundera" }, { "affiliations": [ "Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada", "KITE Research Institute, Toronto Rehabilitation Institute, Toronto, Ontario, Canada" ], "name": "Nancy M Salbach" }, { "affiliations": [ "Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong" ], "name": "Matthew T V Chan" }, { "affiliations": [ "Department of Medicine, University Health Network, Toronto, Ontario, Canada", "Department of Medicine, University of Toronto, Toronto, Ontario, Canada" ], "name": "Shabbir M H Alibhai" }, { "affiliations": [ "Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada" ], "name": "Martine T E Puts" }, { "affiliations": [ "Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada", "Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada", "Sunnybrook Research Institute, Toronto, Ontario, Canada" ], "name": "Angela Jerath" }, { "affiliations": [ "Department of Surgery, University of Alberta, Edmonton, Alberta, Canada", "Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Rachel Khadaroo" }, { "affiliations": [ "Applied Health Research Centre, Unity Health Toronto, Toronto, Ontario, Canada" ], "name": "Sahar Ehtesham" }, { "affiliations": [ "Department of Anesthesia, St Michael’s Hospital, Toronto, Ontario, Canada" ], "name": "Janneth Pazmino-Canizares" }, { "affiliations": [ "Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada", "Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada" ], "name": "Karim S Ladha" }, { "affiliations": [ "Department of Medicine, University Health Network, Toronto, Ontario, Canada", "Department of Medicine, University of Toronto, Toronto, Ontario, Canada" ], "name": "John T Granton" }, { "affiliations": [ "Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada", "Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada" ], "name": "Leandra Amado" }, { "affiliations": [ "Department of Medicine, Universite de Montreal, Montreal, Quebec, Canada", "Department of Medicine, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada" ], "name": "Emmanuelle Duceppe" }, { "affiliations": [ "Acute Care Research Program, Ottawa Hospital Research Institute CIR, Ottawa, Ontario, Canada" ], "name": "Emily Hladkowicz" }, { "affiliations": [ "Department of Anesthesiology and Perioperative Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada", "Department of Anesthesiology and Pain Medicine, The University of British Columbia, Vancouver, British Columbia, Canada" ], "name": "Susan M Lee" }, { "affiliations": [ "Department of Anesthesiology and Pain Medicine, The University of British Columbia, Vancouver, British Columbia, Canada", "Department of Anesthesia, St Paul’s Hospital, Vancouver, British Columbia, Canada" ], "name": "Su-Yin Macdonell" }, { "affiliations": [ "Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada", "Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada", "Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada", "Interdepartmental Division of Critical Care Medicine, University Health Network, Toronto, Ontario, Canada" ], "name": "Matteo Parotto" }, { "affiliations": [ "Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada", "Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada" ], "name": "Anahi Perlas" }, { "affiliations": [ "Department of Surgery, McMaster University, Hamilton, Ontario, Canada" ], "name": "Pablo E Serrano" }, { "affiliations": [ "Department of Anesthesiology, Pain and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada" ], "name": "Mullein D Thorleifson" }, { "affiliations": [ "Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario, Canada" ], "name": "Janet M van Vlymen" }, { "affiliations": [ "Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands" ], "name": "Judith van Waes" }, { "affiliations": [ "Patient and Family Partner Program, Unity Health Toronto, Toronto, Ontario, Canada" ], "name": "Elizabeth Racz" }, { "affiliations": [ "Patient and Family Partner Program, Unity Health Toronto, Toronto, Ontario, Canada" ], "name": "Luke Wilmhurst" }, { "affiliations": [ "Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada", "Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada" ], "name": "Daniel I McIsaac" }, { "affiliations": [], "name": "FAST Walk Study Investigators" } ], "title": "Functional Assessment for Surgery by a Timed Walk (FAST Walk) study: protocol for a multicentre prospective cohort study of the 6 min walk test for preoperative risk stratification in major non-cardiac surgery", "uid": "014af34b-970c-5899-aa3b-d6102ff50071" }