title: Poor preoperative nutritional status is an important predictor of the retardation of rehabilitation after cardiac surgery in elderly cardiac patients.
abstract: BACKGROUND
  Preoperative nutritional status and physical function are important predictors of mortality and morbidity after cardiac surgery. However, the influence of nutritional status before cardiac surgery on physical function and the progress of postoperative rehabilitation requires clarification.
  
  
  OBJECTIVE
  To determine the effect of preoperative nutritional status on preoperative physical function and progress of rehabilitation after elective cardiac surgery.
  
  
  METHODS
  We enrolled 131 elderly patients with mean age of 73.7 ± 5.8 years undergoing cardiac surgery. We divided them into two groups by nutritional status as measured by the Geriatric Nutritional Risk Index (GNRI): high GNRI group (GNRI ≥ 92, n = 106) and low GNRI group (GNRI < 92, n = 25). Physical function was estimated by handgrip strength, knee extensor muscle strength (KEMS), the Short Physical Performance Battery (SPPB), and 6-minute walk test (6MWT). Progress of postoperative rehabilitation was evaluated by the number of days to independent walking after surgery, length of stay in the ICU, and length of hospital stay.
  
  
  RESULTS
  After adjusting for potential confounding factors, preoperative handgrip strength (P = 0.034), KEMS (P = 0.009), SPPB (P < 0.0001), and 6MWT (P = 0.012) were all significantly better in the high GNRI group. Multiple regression analysis revealed that a low GNRI was an independent predictor of the retardation of postoperative rehabilitation.
  
  
  CONCLUSIONS
  Preoperative nutritional status as assessed by the GNRI could reflect perioperative physical function. Preoperative poor nutritional status may be an independent predictor of the retardation of postoperative rehabilitation in patients undergoing elective cardiac surgery.
authors.affiliation: Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan.|Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo, 654-0142, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo, 654-0142, Japan. izawapk@ga2.so-net.ne.jp.
authors.forename: Kazuhiro P
authors.initials: KP
authors.lastname: Izawa
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Seimi
authors.initials: S
authors.lastname: Satomi-Kobayashi
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Kitamura
authors.affiliation: Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo, 654-0142, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Ono
authors.affiliation: Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yoshitada
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000534:rehabilitation; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007564:Japan; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D015596:Nutrition Assessment; D009752:Nutritional Status / Q000502:physiology*; D011300:Preoperative Care / Q000379:methods; D016896:Treatment Outcome; D000070857:Walk Test / Q000379:methods
keywords: Cardiac surgery; Geriatric Nutritional Risk Index; Nutritional status; Physical function; Postoperative rehabilitation