title: Evaluating the association of preoperative functional status and postoperative functional decline in older patients undergoing major surgery.
abstract: This prospective cohort study sought to identify predictors of functional decline in patients aged 65 years or older who underwent major, nonemergent abdominal or thoracic surgery in our tertiary hospital from 2006 to 2008. We used the Stanford Health Assessment Questionnaire-Disability  Index (HAQ-DI) to evaluate functional decline; a 0.1 or greater increase was used to indicate a clinically significant decline. The preoperative Duke Activity Status Index (DASI) and a physical function score (PFS), assessing gait speed, grip strength, balance, and standing speed, were evaluated  as predictors of decline. We enrolled 215 patients (71.2 ± 5.2 years; 56.7% female); 204 completed follow-up HAQ assessments (71.1 ± 5.3 years; 57.8% female). A significant number of patients had functional decline out to 1 year. Postoperative HAQ-DI increases of 0.1 or greater  occurred in 45.3 per cent at 1 month, 30.1 per cent at 3 months, and 28.3 per cent at 1 year. Preoperative DASI and PFS scores were not predictors of functional decline. Male sex at 1 month (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.41 to 6.85); American Society of Anesthesiologists  class (OR, 3.41; 95% CI, 1.31 to 8.86), smoking (OR, 3.15; 95% CI, 1.27 to 7.85), and length of stay (OR, 1.09; 95% CI, 1.01 to 1.16) at 3 months; and cancer diagnosis at 1 year (OR, 2.6; 95% CI, 1.14 to 5.96) were associated with functional decline.
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington, USA. skwon11@u.washington.edu
authors.forename: Steve
authors.initials: S
authors.lastname: Kwon
authors.forename: Rebecca
authors.initials: R
authors.lastname: Symons
authors.forename: Michi
authors.initials: M
authors.lastname: Yukawa
authors.forename: Nikolas
authors.initials: N
authors.lastname: Dasher
authors.forename: Victor
authors.initials: V
authors.lastname: Legner
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004185:Disability Evaluation; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006304:Health Status; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010809:Physical Fitness / Q000502:physiology*; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D018570:Risk Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods