Functional decline after major elective non-cardiac surgery: a multicentre prospective cohort study

Area of Science:

• Peri-operative Medicine
• Patient-Centered Outcomes Research
• Surgical Outcomes

Background:

• Self-reported functional recovery is a crucial patient-centered outcome often overlooked in surgical research.
• Assessing peri-operative factors influencing functional decline is vital for improving patient care after major non-cardiac surgery.

Purpose of the Study:

• To analyze associations between peri-operative variables and functional decline up to one year after major non-cardiac surgery.
• To investigate the impact of postoperative complications on patient-reported functional outcomes.

Main Methods:

• Secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study.
• Inclusion of patients aged 40+ undergoing major non-cardiac surgery, with or at risk of coronary artery disease.
• Assessment of functional decline using the EuroQol 5-dimension (EQ-5D) measure at 30 days and 1 year post-surgery.

Main Results:

• 40% of patients reported functional decline at 30 days, decreasing to 24% at 1 year.
• Higher pre-operative Duke Activity Status Index scores were associated with more frequent short-term functional decline but less long-term decline.
• Moderate to severe postoperative complications increased the odds of functional decline at 30 days (OR 1.46) and 1 year (OR 1.44).

Conclusions:

• A significant proportion of patients experience persistent functional decline for up to a year after major non-cardiac surgery.
• Postoperative complications are associated with increased functional decline, emphasizing the importance of complication management.
• Predictive models for functional decline showed poor discrimination, suggesting a need for improved assessment tools.