Natural History of Functional Recovery After Major Abdominal Surgery in Elders

Session number: 1016

Abstract title: Natural History of Functional Recovery After Major Abdominal Surgery in Elders

Author(s):
Lawrence VA - Audie Murphy Division, South Texas Veterans Health Care System and The University of Texas Health Science Center at San Antonio
Hazuda HP - Audie Murphy Division, South Texas Veterans Health Care System and The University of Texas Health Science Center at San Antonio
Cornell J - Audie Murphy Division, South Texas Veterans Health Care System and The University of Texas Health Science Center at San Antonio
Mulrow CD - Audie Murphy Division, South Texas Veterans Health Care System and The University of Texas Health Science Center at San Antonio

Objectives: To conduct the sentinel systematic study of the natural history of functional recovery in elders after major abdominal surgery.

Methods: Prospective cohort study of 372 consecutive patients >;=60 years old, assessed preoperatively (preop) and postoperatively (postop) at 1, 3, and 6 weeks, 3 and 6 months. Self-report and performance-based measures included ADL, IADL, MOS SF-36, timed walk, and grip strength.

Results: Patients were 56% male with mean age of 69+;-6.4. Settings were tertiary care academic VA and university hospitals (19% and 32% of patients) and private hospitals (49%). Surgeries included aortic (n = 88, 24%), upper abdominal (n = 52, 14%), ventral hernia (n = 69, 17%), partial or total colon resections (n = 143, 38%), and other lower abdominal procedures (n = 20, 5%). Mean ADL score worsened from 7.5+;-1.3 preop to 10.3+;-3.7 (p<0.0001) 1 week postop, remained significantly worse than preop through 6 weeks (p<;=0.001), and returned to preop level by 3 months. Mean IADL score worsened from 9.6+;-2.4 preop to 17.3+;-4.8 (p<0.0001) 1 week postop and remained significantly worse than preop until 6 months. Mean timed walk returned to baseline by 3 months while mean grip strength remained significantly worse than preop 6 months after surgery. Mean SF-36 physical component score worsened significantly at 3 and 6 weeks postop (p<0.0001, 0.011). Mean SF-36 mental component score did not change postop. Proportions of patients not recovered at 6 months postop were: ADL - 9%; IADL -19%; SF-36 physical and mental components – 16%, 17%; timed walk – 39%; grip strength – 52%.

Conclusions: Recovery trajectories vary for different domains of function. Substantial numbers of elders do not return to preop functional status as long as 6 months after surgery.

Impact statement: These data provide important natural history information for immediate clinical use in counseling patients and their families. With a large and growing number of elders potentially needing surgery, this systematic evidence about the course of recovery is vital to identifying predictors of healthy recovery and interventions to improve recovery.