title: The impact of postoperative complications on the recovery of elderly surgical patients.
abstract: While the negative impact of postoperative complications on hospital costs, survival, and cancer recurrence is well known, few studies have quantified the impact of postoperative complications on patient-centered outcomes such as functional status. The objective of this study was to estimate the impact of postoperative complications on recovery of functional status after elective abdominal surgery in elderly patients.
  
  
  
  Elderly patients (70 years and older) undergoing elective abdominal surgery, with a planned length of stay >1 day, were prospectively enrolled between July 2012 and December 2014. The primary outcome was time to recovery to the preoperative functional status measured by the short physical performance battery (SPPB) preoperatively and at 1 week, 1, 3, and 6 months after surgery. The comprehensive complication index was calculated to grade the severity and number of postoperative complications. A Weibull survival model with interval censoring was performed, controlling for age, sex, body mass index (BMI), comorbidities (Charlson comorbidity index-CCI), frailty, presence of cancer, nutritional status, wound class, preoperative functional status, and surgical approach.
  
  
  
  Hundred and forty-nine patients (79 men and 70 women) were included in the analysis. Mean age was 77.7 ± 4.9 years, mean BMI was 27.2 ± 5.5 kg/m(2), and the median CCI was 3 (IQR 2-6). The mean preoperative SPPB score was 9.62 ± 2.33. A total of 52 patients (34.9 %) experienced one or more postoperative complications, including four mortalities, and a total of 72 complications. The mean comprehensive complication index score for these patients was 25.7 ± 23.8. In the presence of all other variables included in the model, a higher comprehensive complication index score was found to significantly decrease the hazard of recovery (HR 0.96, CI 0.94-0.98, p value = 0.0004) and hence increase the time to recovery.
  
  
  
  Following elective abdominal surgery, elderly patients who experience a greater number and more severe postoperative complications take longer to return to their preoperative functional status.
authors.affiliation: Division of General Surgery, Department of Surgery, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.|Lady Davis Institute for Medical Research, Montreal, Canada.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Tahiri
authors.affiliation: Lady Davis Institute for Medical Research, Montreal, Canada.|St-Mary's Hospital Center, McGill University, Montreal, Canada.
authors.forename: Tarifin
authors.initials: T
authors.lastname: Sikder
authors.affiliation: Lady Davis Institute for Medical Research, Montreal, Canada.
authors.forename: Geva
authors.initials: G
authors.lastname: Maimon
authors.affiliation: Lady Davis Institute for Medical Research, Montreal, Canada.
authors.forename: Debby
authors.initials: D
authors.lastname: Teasdale
authors.affiliation: Division of General Surgery, Department of Surgery, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
authors.forename: Fadi
authors.initials: F
authors.lastname: Hamadani
authors.affiliation: Lady Davis Institute for Medical Research, Montreal, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Sourial
authors.affiliation: Steinberg-Bernstein Center for Minimally Invasive Surgery, McGill University, Montreal, Canada.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Guralnick
authors.affiliation: Division of General Surgery, Department of Surgery, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
authors.forename: Shanon A
authors.initials: SA
authors.lastname: Fraser
authors.affiliation: St-Mary's Hospital Center, McGill University, Montreal, Canada.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Demyttenaere
authors.affiliation: Division of General Surgery, Department of Surgery, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada. simon.bergman@mcgill.ca.|Lady Davis Institute for Medical Research, Montreal, Canada. simon.bergman@mcgill.ca.
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
mesh_terms: D000005:Abdomen / Q000601:surgery; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000534:rehabilitation*; D020127:Recovery of Function; D012189:Retrospective Studies
keywords: Abdominal surgery; Complications; Comprehensive complication index; Elderly; Functional recovery; Short physical performance battery test