Functional Status is a Predictor of Postoperative Complications After Cancer Surgery in the Very Old

The association between preoperative functional status and postoperative complications after cancer surgery is very well described in the 'youngest old' population; however, limited information is available for the very old (i.e. those aged 80 years and older).

Our aim was to evaluate whether functional status, expressed as metabolic equivalents (METs), is a predictor of adverse postoperative outcomes in very old patients.

In a retrospective cohort study, we included all patients aged 80 years or older who underwent elective oncological surgery at a tertiary hospital in Brazil in 2011. The primary outcome was postoperative complications up to 30 days after surgery. Functional status was evaluated using a simple questionnaire, which classified participants into three groups based on METs. We used logistic regression models to investigate the association between functional status and the occurrence of complications, adjusted for possible confounders.

We analyzed data from 138 patients aged 80 years or older. The mean age of the sample was 84.2 ± 4.2 years and 52% were female; 65% of the procedures were classified as low risk and 35% were classified as intermediate risk. Regarding functional status, 72% of the sample had a performance equivalent to fewer than 4 METs, 27% had 4-6 METs, and 1% had more than 6 METs. Postoperative complications were observed in 25%, and the mortality rate was 2%. Better functional status was associated with reduced odds of postoperative complications in multivariate analysis (odds ratio 0.11, 95% confidence interval 0.02-0.85; p = 0.034).

Functional status seems to be related to surgical morbidity in the very old.