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Risk assessment for loss of independence after hepatopancreaticobiliary surgery in the elderly: a prospective
Takahito Kawaguchi1, Shogo Tanaka2, Masao Ogawa3
1Department of Hepatobiliarypancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Background:
Maintaining an independent life after hepatopancreaticobiliary surgery is a major goal of elderly people. This prospective study aimed to identify the risk factors for postoperative loss of independence after hepatopancreaticobiliary surgery in elderly individuals.
Methods:
Between February 2023 and December 2023, independently living elderly individuals aged ≥65 years who were scheduled for hepatopancreaticobiliary surgery and approved for preoperative evaluation of frailty at 5 institutions were registered. Frailty was evaluated the "Kihon Checklist," which is a phenotypic frailty index. Postoperative loss of independence was defined as hospitalization, need for nursing care, and/or transfer to a rehabilitation facility at 90 days and/or mortality within 90 days.
Results:
Of the 201 registered patients, 58 (28.9%) were classified as frail, and 21 (10.4%) developed postoperative loss of independence. Univariate and multivariate analyses indicated that frailty (P =.03), cerebrovascular and/or neurological diseases (P =.04), and open surgery (P =.02) were independent risk factors for postoperative loss of independence after hepatopancreaticobiliary surgery. Among the patients with postoperative loss of independence, 2.8% had no applicable risk factors, and 31.4% had ≥2 of these factors (P <.001). The incidence of postoperative loss of independence was 9.4% in the frail patients who underwent minimally invasive surgery (MIS) and 30.8% in those who underwent open surgery (P = .050).
Conclusion:
Postoperative loss of independence was predictable among elderly patients identified as frail using the Kihon Checklist after hepatopancreaticobiliary surgery. MIS for elderly individuals with frailty may reduce the risk of postoperative loss of independence.
