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

This study evaluated the impact of major elective surgery on performance status, defined as functional and cognitive status, in older adults 3 months postoperatively. Secondary endpoints included assessing the need for domiciliary care, rehospitalization, or institutionalization, and evaluating associations with anesthesia type.

In this observational prospective cohort study, 169 patients aged ≥ 70 underwent major elective surgery between May 2020 and June 2023; 150 had complete information at 3-months (T3). Decline in performance status, either functional or cognitive, was defined as a ≥ 10-point worsening in the Barthel Index (BI) or death, or a ≥ 3-point decline in Mini-Mental State Examination (MMSE), all measured 3 months after surgery.

Mean (SD) age was 77 (5) years, with a mean (SD) Charlson Comorbidity Index (CCI) of 7 (2). Most surgeries (133, 79%) were performed for oncologic indications. Baseline median [IQR] BI was 100 [100-100], and MMSE was 27 [25-28]. At T3, 44 (29%) patients showed a ≥ 10-point BI decline (p < 0.001) and 7 died, while 14% exhibited a ≥ 3-point MMSE decrease. Domiciliary care was required in 14 (9%) patients, while 26 (17%) were institutionalized. Fifty-five (37%) patients reported health sequelae within 3 months post-surgery. Multivariable regression analysis associated higher CCI and post-discharge health issues with BI decline or death, but not with MMSE. Domiciliary care needs or rehospitalization was linked to elevated CCI and laparotomic approach.

Major elective surgery may compromise functional status in nearly one-third of older patients, especially those with high comorbidity and post-discharge sequelae. Cognitive decline was less prevalent, and the need for domiciliary or institutional care was relatively low. Trial Registration: URL: https://register.clinicaltrials.gov/prs/beta/studies/S000CLIN00000033/recordSummary; Clinicaltrials.gov identifier: NCT05594277.