Major Elective Surgery Impact on Performance Status in Older Adults: A Prospective Observational Study

Area of Science:

• Geriatric Medicine
• Surgical Outcomes
• Postoperative Care

Background:

• Older adults undergoing major elective surgery face risks to their functional and cognitive status.
• Assessing postoperative performance is crucial for managing health outcomes in this demographic.

Purpose of the Study:

• To evaluate the impact of major elective surgery on the functional and cognitive status of older adults 3 months postoperatively.
• To identify secondary outcomes such as need for care, rehospitalization, institutionalization, and associations with anesthesia type.

Main Methods:

• An observational prospective cohort study included 169 patients aged 70 years or older undergoing major elective surgery.
• Performance status was assessed using the Barthel Index (BI) for functional status and the Mini-Mental State Examination (MMSE) for cognitive status at 3 months post-surgery.
• Decline was defined as a ≥10-point BI worsening or death, or a ≥3-point MMSE decrease.

Main Results:

• Nearly one-third (29%) of patients experienced a significant decline in functional status (BI decline or death).
• Cognitive decline (MMSE decrease) was observed in 14% of patients.
• Higher Charlson Comorbidity Index (CCI) and post-discharge health issues were associated with functional decline, while CCI and laparotomic approach were linked to increased need for domiciliary care or rehospitalization.

Conclusions:

• Major elective surgery can significantly compromise functional status in older adults, particularly those with high comorbidity.
• Cognitive decline is less common, and the need for institutional or domiciliary care remains relatively low.
• Identifying patients at risk for functional decline is essential for optimizing postoperative care and outcomes.