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Updated: Oct 23, 2025

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

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Published on: September 30, 2020

Hospitalization-Associated Disability After Cardiac Surgery in Elderly Patients　- Exploring the Risk Factors Using

Kentaro Hori¹, Koyo Usuba^2,3, Akihiro Sakuyama⁴

¹Department of Rehabilitation, Sakakibara Heart Institute Tokyo Japan.

Circulation Reports

|August 20, 2021

Summary

Hospitalization-associated disability (HAD) affects 5.2% of elderly cardiac surgery patients. Key risk factors include frailty indicators and delayed ambulation, highlighting the need for preoperative rehabilitation and early mobilization.

Keywords:

Cardiac surgery Elderly patients Hospitalization-associated disability Machine learning algorithms Risk factor

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Published on: June 10, 2025

Area of Science:

Gerontology
Cardiology
Clinical Medicine

Background:

Hospitalization-associated disability (HAD) leads to functional decline and mortality in elderly patients post-discharge.
Identifying risk factors for HAD is crucial for improving outcomes in elderly individuals undergoing cardiac surgery.

Purpose of the Study:

To determine the incidence and identify risk factors associated with HAD in elderly patients undergoing elective cardiac surgery in Japan.

Main Methods:

Retrospective analysis of 2,059 elderly patients undergoing cardiac surgery.
HAD defined as functional decline (Barthel Index) from admission to discharge.
Machine learning algorithms used to identify risk factors for HAD.

Main Results:

108 patients (5.2%) developed HAD.
Identified risk factors include age, low serum albumin, impaired kidney function, cognitive impairment, NT-proBNP levels, low vital capacity, low preoperative SPPB scores, longer operation/bypass/ventilator times, prolonged ICU stay, and delayed ambulation.
Highest HAD incidence (76.9%) in patients with SPPB ≤9 or ambulation start >6 days post-surgery.

Conclusions:

Several identified risk factors for HAD are linked to frailty, suggesting preoperative rehabilitation can mitigate risk.
Early mobilization and rehabilitation are critical, as evidenced by the association between delayed ambulation and increased HAD incidence.