P-429: Gait speed as predictor of outcomes of elective cardiac surgery in older patients

Betomvuko, P.; Michaux, Isabelle; Laurent, Gabriel; Bihin, Benoît; Gourdin, Maximilien; Hubert, Marie de Saint

doi:10.1016/s1878-7649(15)30526-x

Cited by 2 publications

(3 citation statements)

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“…In our previous work in the nursing home population, we showed that functional and cognitive impairment were strongly associated with 1-year mortality and functional decline in women undergoing surgery for breast cancer . Other studies, generally single-centered, have found that preoperative physical and cognitive function are associated with short-term mortality (ie, 30-day, 6-month) . One national study found that preoperative cognition and function was associated with 30-day mortality in older surgical adults .…”

Section: Discussionmentioning

confidence: 78%

“…21 Other studies, generally single-centered, have found that preoperative physical and cognitive function are associated with short-term mortality (ie, 30-day, 6-month). [22][23][24] One national study found that preoperative cognition and function was associated with 30-day mortality in older surgical adults. 25 This increasing body of literature supports the importance of functional and cognitive assessments in the preoperative setting, specifically for older adults undergoing major surgery.…”

Section: Discussionmentioning

confidence: 99%

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Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery

et al. 2020

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IMPORTANCE More older adults are undergoing major surgery despite the greater risk of postoperative mortality. Although measures, such as functional, cognitive, and psychological status, are known to be crucial components of health in older persons, they are not often used in assessing the risk of adverse postoperative outcomes in older adults.OBJECTIVE To determine the association between measures of physical, cognitive, and psychological function and 1-year mortality in older adults after major surgery. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of a prospective cohort study of participants 66 years or older who were enrolled in the nationally representative Health and Retirement Study and underwent 1 of 3 types of major surgery.EXPOSURES Major surgery, including abdominal aortic aneurysm repair, coronary artery bypass graft, and colectomy. MAIN OUTCOMES AND MEASURESOur outcome was mortality within 1 year of major surgery. Our primary associated factors included functional, cognitive, and psychological factors: dependence in activities of daily living (ADL), dependence in instrumental ADL, inability to walk several blocks, cognitive status, and presence of depression. We adjusted for other demographic and clinical predictors. RESULTSOf 1341 participants, the mean (SD) participant age was 76 (6) years, 737 (55%) were women, 99 (7%) underwent abdominal aortic aneurysm repair, 686 (51%) coronary artery bypass graft, and 556 (42%) colectomy; 223 (17%) died within 1 year of their operation. After adjusting for age, comorbidity burden, surgical type, sex, race/ethnicity, wealth, income, and education, the following measures were significantly associated with 1-year mortality: more than 1 ADL dependence (29% vs 13%; adjusted hazard ratio [aHR], 2.76; P = .001), more than 1 instrumental ADL dependence (21% vs 14%; aHR, 1.32; P = .05), the inability to walk several blocks (17% vs 11%; aHR, 1.64; P = .01), dementia (21% vs 12%; aHR, 1.91; P = .03), and depression (19% vs 12%; aHR, 1.72; P = .01). The risk of 1-year mortality increased within the increasing risk factors present (0 factors: 10.0%; 1 factor: 16.2%; 2 factors: 27.8%). CONCLUSIONS AND RELEVANCEIn this older adult cohort, 223 participants (17%) who underwent major surgery died within 1 year and poor function, cognition, and psychological well-being were significantly associated with mortality. Measures in function, cognition, and psychological well-being need to be incorporated into the preoperative assessment to enhance surgical decision-making and patient counseling.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery

et al. 2020

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“…The association between preoperative prognostic factors and postoperative mortality was investigated in 11 studies (3399 patients) (Table 2 ) [ 1 – 3 , 25 , 30 , 32 , 51 , 53 , 55 – 57 ]. The pooled incidence of mortality was 4.58% (95% CI 3.67–5.71%, 11 studies, I 2 = 46.30%, NNF = 21) [ 1 – 3 , 25 , 30 , 32 , 51 , 53 , 55 – 57 ]. Among patients undergoing cardiac surgery, the pooled incidence of mortality was 5.21% (4.00–6.75%, 6 studies, I 2 = 60.8%, NNF = 20).…”

Section: Resultsmentioning

confidence: 99%

Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis

Watt

Tricco

Talbot-Hamon

et al. 2018

BMC Med

149

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BackgroundElective surgeries can be associated with significant harm to older adults. The present study aimed to identify the prognostic factors associated with the development of postoperative complications among older adults undergoing elective surgery.MethodsMedline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. Prospective studies reporting prognostic factors associated with postoperative complications (composite outcome of medical and surgical complications), functional decline, mortality, post-hospitalization discharge destination, and prolonged hospitalization among older adults undergoing elective surgery were included. Study characteristics and prognostic factors associated with the outcomes of interest were extracted independently by two reviewers. Random effects meta-analysis models were used to derive pooled effect estimates for prognostic factors and incidences of adverse outcomes.ResultsOf the 5692 titles and abstracts that were screened for inclusion, 44 studies (12,281 patients) reported on the following adverse postoperative outcomes: postoperative complications (n =28), postoperative mortality (n = 11), length of hospitalization (n = 21), functional decline (n = 6), and destination at discharge from hospital (n = 13). The pooled incidence of postoperative complications was 25.17% (95% confidence interval (CI) 18.03–33.98%, number needed to follow = 4). The geriatric syndromes of frailty (odds ratio (OR) 2.16, 95% CI 1.29–3.62) and cognitive impairment (OR 2.01, 95% CI 1.44–2.81) were associated with developing postoperative complications; however, there was no association with traditionally assessed prognostic factors such as age (OR 1.07, 95% CI 1.00–1.14) or American Society of Anesthesiologists status (OR 2.62, 95% CI 0.78–8.79). Besides frailty, other potentially modifiable prognostic factors, including depressive symptoms (OR 1.77, 95% CI 1.22–2.56) and smoking (OR 2.43, 95% CI 1.32–4.46), were also associated with developing postoperative complications.ConclusionGeriatric syndromes are important prognostic factors for postoperative complications. We identified potentially modifiable prognostic factors (e.g., frailty, depressive symptoms, and smoking) associated with developing postoperative complications that can be targeted preoperatively to optimize care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0986-2) contains supplementary material, which is available to authorized users.

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P-429: Gait speed as predictor of outcomes of elective cardiac surgery in older patients

Cited by 2 publications

References 0 publications

Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery

Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery

Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis

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