Inflammation, functional status, and weight loss during recovery from cardiac surgery in older adults: a pilot study.
OBJECTIVE
To determine the nutritional, inflammatory, and functional aspects of unintentional weight loss after cardiac surgery that warrant further investigation.


METHODS
Twenty community-dwelling adults > 65 years old undergoing cardiac surgery (coronary artery bypass graft [CABG] or CABG + valve) were recruited for this prospective longitudinal (preoperative and 4-6 weeks postdischarge) pilot study. Anthropometrics (weight, standing height, and mid-arm and calf circumference), nutritional status (Mini-Nutritional Assessment™ [MNA]), appetite, physical performance (timed chair stand), muscle strength (hand grip) and functional status (basic and instrumental activities of daily living), and inflammatory markers (plasma leptin, ghrelin, interleukin [IL]-6, high-sensitivity[hs] C-reactive protein, and serum albumin and prealbumin) were measured.


RESULTS
Participants who completed the study (n = 11 males, n = 3 females) had a mean age 70.21 ± 4.02 years. Of these, 12 lost 3.66 ± 1.44 kg over the study period. Weight, BMI, activities of daily living, and leptin decreased over time (p < .05). IL-6 increased over time (p < .05). Ghrelin, hs-CRP, and timed chair stand increased over time in those who underwent combined procedures (p < .05). Grip strength decreased in those who developed complications (p = .004). Complications, readmission status, and lowered grip strength were found in those with low preoperative MNA scores (p < .05).


CONCLUSIONS
After cardiac surgery, postdischarge weight loss occurs during a continued inflammatory response accompanied by decreased physical functioning and may not be a positive outcome. The impacts of weight loss, functional impairment, and inflammation during recovery on disability and frailty warrant further study.
Doctoral Nursing Department and Nutrition Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA rad83@drexel.edu.
Rose Ann
RA
DiMaria-Ghalili
College of Nursing, New York University, New York, NY, USA.
Eileen M
EM
Sullivan-Marx
School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
Charlene
C
Compher
D000368:Aged; D000886:Anthropometry; D001066:Appetite / Q000502:physiology; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D003289:Convalescence; D001026:Coronary Artery Bypass; D003863:Depression / Q000209:etiology; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D015596:Nutrition Assessment; D010359:Patient Readmission; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D015431:Weight Loss / Q000502:physiology*
D015415:Biomarkers
IL-6; MNA; cardiac surgery; hand-grip strength; timed chair stand; weight loss