title: Functional Status is a Predictor of Postoperative Complications After Cancer Surgery in the Very Old.
abstract: BACKGROUND
  The association between preoperative functional status and postoperative complications after cancer surgery is very well described in the 'youngest old' population; however, limited information is available for the very old (i.e. those aged 80 years and older).
  
  
  OBJECTIVE
  Our aim was to evaluate whether functional status, expressed as metabolic equivalents (METs), is a predictor of adverse postoperative outcomes in very old patients.
  
  
  METHODS
  In a retrospective cohort study, we included all patients aged 80 years or older who underwent elective oncological surgery at a tertiary hospital in Brazil in 2011. The primary outcome was postoperative complications up to 30 days after surgery. Functional status was evaluated using a simple questionnaire, which classified participants into three groups based on METs. We used logistic regression models to investigate the association between functional status and the occurrence of complications, adjusted for possible confounders.
  
  
  RESULTS
  We analyzed data from 138 patients aged 80 years or older. The mean age of the sample was 84.2 ± 4.2 years and 52% were female; 65% of the procedures were classified as low risk and 35% were classified as intermediate risk. Regarding functional status, 72% of the sample had a performance equivalent to fewer than 4 METs, 27% had 4-6 METs, and 1% had more than 6 METs. Postoperative complications were observed in 25%, and the mortality rate was 2%. Better functional status was associated with reduced odds of postoperative complications in multivariate analysis (odds ratio 0.11, 95% confidence interval 0.02-0.85; p = 0.034).
  
  
  CONCLUSIONS
  Functional status seems to be related to surgical morbidity in the very old.
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil. marcos.saraiva@fm.usp.br.
authors.forename: Marcos Daniel
authors.initials: MD
authors.lastname: Saraiva
authors.affiliation: Division of Geriatrics, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
authors.forename: Theodora
authors.initials: T
authors.lastname: Karnakis
authors.affiliation: Division of Geriatrics, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
authors.forename: Luiz Antonio
authors.initials: LA
authors.lastname: Gil-Junior
authors.affiliation: Division of Internal Medicine, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
authors.forename: Julio Cesar
authors.initials: JC
authors.lastname: Oliveira
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Claudia Kimie
authors.initials: CK
authors.lastname: Suemoto
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Jacob-Filho
mesh_terms: D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D055686:Metabolic Equivalent; D009369:Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires