Functional decline of older patients 1 year after cardiothoracic surgery followed by intensive care admission: a prospective longitudinal cohort study.
BACKGROUND
there is a growing demand for cardiothoracic surgery in patients' aged ≥65 years.


OBJECTIVE
: to explore which variables were independently associated with functional decline 12 months after cardiothoracic surgery followed by intensive care admission.


METHODS
prospective cohort study.


METHODS
cardiothoracic unit of a university teaching hospital.


METHODS
a total of 356 elderly patients undergoing cardiothoracic surgery followed by intensive care unit admission.


METHODS
functioning was assessed at hospital admission and 3 and 12 months after hospital discharge with the modified Katz activities of daily living (ADL) index. Data collection included demographics, surgical procedure, diagnosis, comorbidities, pre-morbid geriatric conditions and intensive care unit length of stay. Functional decline was defined as a one-point loss on the modified Katz ADL index score at 1 year compared with baseline functioning at hospital admission. Logistic regression analysis was performed to study the association between independent variables and functional decline.


RESULTS
the 1-year mortality rate was 8.7% of which 4.8% was in-hospital mortality. The youngest group consisted of 295 patients (64% men; 72 ± 4 years), there were 61 octogenarians (56% men; 82 ± 2 years). One year after hospital discharge, younger patients demonstrated less functional decline (45 versus 56%, P < 0.001). Cognitive impairment, higher age, female gender, alcohol use, type of cardiac procedure and serum creatinine were independently associated with functional decline 1 year after discharge.


CONCLUSIONS
the survival rates after cardiothoracic surgery were good, the rates of functional decline were substantial. These results suggest that studies on geriatric rehabilitation before and after surgery might be needed to overcome the decline in functioning.
Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, PO Box 22660, Amsterdam 1100 DD, The Netherlands.
Annerike C
AC
Govers
Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, PO Box 22660, Amsterdam 1100 DD, The Netherlands.
Bianca M
BM
Buurman
Department of Geriatrics, Rijnland Ziekenhuis, Leiderdorp, The Netherlands.
Peter
P
Jue
Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Bas A J M
BA
de Mol
Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.
Dave A
DA
Dongelmans
Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, PO Box 22660, Amsterdam 1100 DD, The Netherlands.
Sophia E
SE
de Rooij
D000203:Activities of Daily Living / Q000523:psychology*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003422:Critical Care / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D011446:Prospective Studies; D012737:Sex Factors; D013903:Thoracic Surgery
D003404:Creatinine
cardiothoracic surgery; cognition; cognitive; functional decline; functional status; geriatric; hospitalisation; intensive care admission; older people; patient-reported outcomes