title: Self-reported Mobility in Older Patients Predicts Early Postoperative Outcomes after Elective Noncardiac Surgery.
abstract: BACKGROUND
  Specific geriatric assessment tools may complement traditional perioperative risk stratification. The aim of this study was to evaluate whether self-reported mobility is predictive of postoperative outcomes in older patients undergoing elective noncardiac surgery.
  
  
  METHODS
  Patients aged 69 yr or older (n = 197) underwent (1) traditional risk assessments (American Society of Anesthesiologists physical status classification and Revised Cardiac Risk Index), (2) five-point frailty evaluation, (3) self-reported mobility assessment using the Mobility Assessment Tool-short form (range, 30.21 [poor] to 69.76 [excellent]), and (4) measurements of high-sensitivity C-reactive protein. Outcomes were postoperative complications, time to discharge, and nursing home placement (NHP).
  
  
  RESULTS
  In the sample of this study (mean age, 75 ± 5 yr; 51% women), 72% had intermediate- or high-risk surgery. Median time to discharge was 3 days (interquartile range, 1 to 4 days). Thirty patients (15%) developed postoperative complications, and 27 (13%) required NHP. After controlling for age, sex, body mass index, pain score, Revised Cardiac Risk Index, American Society of Anesthesiologist physical status, surgical risk, and high-sensitivity C-reactive protein, worse self-reported mobility (per 10-point decrease in Mobility Assessment Tool, which is equivalent to 1 SD) was associated with more postoperative complications (odds ratio [OR], 1.69; 95% CI, 1.05 to 2.73), later time to discharge (hazards ratio, 0.81; 95% CI, 0.68 to 0.96), and increased NHP (OR, 2.01; 95% CI, 1.13 to 3.56). By using the same model, intermediate frailty or frailty increased NHP (OR, 3.11; 95% CI, 1.02 to 9.54) but was not related to either postoperative complications or time to discharge.
  
  
  CONCLUSIONS
  Preoperative self-reported mobility using a novel and brief assessment may help identify elderly patients at risk for adverse postoperative events.
authors.affiliation: From the Department of Internal Medicine, Section of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.K.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina (A.P.M., X.I.L., S.B.K., W.J.R., L.G.); Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina (A.P.M., W.J.R.); Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.R., C.R., L.G.); Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (X.I.L.); Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.K.); Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.G.); and Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.G.).
authors.forename: Sunghye
authors.initials: S
authors.lastname: Kim
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Marsh
authors.forename: Lauren
authors.initials: L
authors.lastname: Rustowicz
authors.forename: Catherine
authors.initials: C
authors.lastname: Roach
authors.forename: Xiaoyan I
authors.initials: XI
authors.lastname: Leng
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
authors.forename: W Jack
authors.initials: WJ
authors.lastname: Rejeski
authors.forename: Leanne
authors.initials: L
authors.lastname: Groban
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D051346:Mobility Limitation; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D057566:Self Report