title: Longitudinal functional recovery after geriatric cardiac surgery.
abstract: BACKGROUND
  Impaired functional and cognitive status is an important outcome for older adults undergoing major cardiac surgery. We conducted this pilot study to gauge feasibility of assessing these outcomes longitudinally, from preoperatively up to two time points postoperatively to assess for recovery.
  
  
  METHODS
  We interviewed patients aged ≥ 65 y preoperatively and repeated functional and cognitive assessments at 4-6 wk and 4-6 mo postoperatively. Simple unadjusted linear regression was used to test whether baseline measures changed at each follow-up time point. Then we used a longitudinal model to predict postoperative recovery overall, adjusting for comorbidity.
  
  
  RESULTS
  A total of 62 patients (age 74.7 ± 5.9) underwent scheduled cardiac surgery. Preoperative activities of daily living (ADL) impairment was associated with poorer functional recovery at 4-6 wk postoperatively with each baseline ADL impairment conferring recovery of 0.5 fewer ADLs (P < 0.05). By 4-6 mo, we could no longer detect a difference in recovery. Preoperative cognition and physical activity were not associated with postoperative changes in these domains.
  
  
  CONCLUSIONS
  A preoperative and postoperative evaluation of function and cognition was integrated into the surgical care of older patients. Preoperative impairments in ADLs may be a means to identify patients who might benefit from careful postoperative planning, especially in terms of assistance with self-care during the first 4-6 wk after cardiac surgery.
authors.affiliation: Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan. Electronic address: lmin@med.umich.edu.
authors.forename: Lillian
authors.initials: L
authors.lastname: Min
authors.affiliation: Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan.
authors.forename: Lauren
authors.initials: L
authors.lastname: Mazzurco
authors.affiliation: Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Tanya R
authors.initials: TR
authors.lastname: Gure
authors.affiliation: Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan.
authors.forename: Christine T
authors.initials: CT
authors.lastname: Cigolle
authors.affiliation: Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan.
authors.forename: Pearl
authors.initials: P
authors.lastname: Lee
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Cathie
authors.initials: C
authors.lastname: Bloem
authors.affiliation: Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Chiao-Li
authors.initials: CL
authors.lastname: Chan
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Romano
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: Division of General Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
authors.affiliation: Divisions of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan.
authors.forename: Preeti N
authors.initials: PN
authors.lastname: Malani
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D003071:Cognition; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010865:Pilot Projects; D020127:Recovery of Function; D011795:Surveys and Questionnaires
keywords: Aging; Cardiac surgery; Cognitive function; Elderly; Functional status; Outcomes