Self-reported Mobility in Older Patients Predicts Early Postoperative Outcomes After Elective Noncardiac Surgery

Overview

Journal Anesthesiology

Specialty Anesthesiology

Date 2016 Mar 16

PMID 26978144

Citations 13

Authors

Sunghye Kim

Anthony P Marsh

Lauren Rustowicz

Catherine Roach

Xiaoyan I Leng

Stephen B Kritchevsky

W Jack Rejeski

Leanne Groban

Affiliations

Soon will be listed here.

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.

Citing Articles

The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery.

Vernooij L, van Klei W, Moons K, Takada T, van Waes J, Damen J Cochrane Database Syst Rev. 2021; 12:CD013139.

PMID: 34931303 PMC: 8689147. DOI: 10.1002/14651858.CD013139.pub2.

How can we minimize the risks by optimizing patient's condition shortly before thoracic surgery?.

Ellenberger C, Schorer R, Bedat B, Hagerman A, Triponez F, Karenovics W Saudi J Anaesth. 2021; 15(3):264-271.

PMID: 34764833 PMC: 8579499. DOI: 10.4103/sja.sja_1098_20.

A pilot study of aquatic prehabilitation in adults with knee osteoarthritis undergoing total knee arthroplasty - short term outcome.

Kim S, Hsu F, Groban L, Williamson J, Messier S BMC Musculoskelet Disord. 2021; 22(1):388.

PMID: 33902505 PMC: 8074697. DOI: 10.1186/s12891-021-04253-1.

Influence of Frailty on Outcome in Older Patients Undergoing Non-Cardiac Surgery - A Systematic Review and Meta-Analysis.

Tjeertes E, van Fessem J, Mattace-Raso F, Hoofwijk A, Stolker R, Hoeks S Aging Dis. 2020; 11(5):1276-1290.

PMID: 33014537 PMC: 7505262. DOI: 10.14336/AD.2019.1024.

Mobility assessment tool may be an efficient method of triaging elective surgical patients.

Clifton J, Freundlich R, Sain C, Grant B, Wanderer J J Clin Anesth. 2019; 60:103-104.

PMID: 31536869 PMC: 6854298. DOI: 10.1016/j.jclinane.2019.09.015.

References

Chung F, Mezei G . Adverse outcomes in ambulatory anesthesia. Can J Anaesth. 1999; 46(5 Pt 2):R18-34. DOI: 10.1007/BF03013179. View

Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146-56. DOI: 10.1093/gerona/56.3.m146. View

Oresanya L, Lyons W, Finlayson E . Preoperative assessment of the older patient: a narrative review. JAMA. 2014; 311(20):2110-20. DOI: 10.1001/jama.2014.4573. View

Robinson T, Wu D, Pointer L, Dunn C, Moss M . Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. J Am Coll Surg. 2012; 215(1):12-7. PMC: 3383613. DOI: 10.1016/j.jamcollsurg.2012.02.007. View

Prause G, Offner A, Ratzenhofer-Komenda B, Vicenzi M, Smolle J, Smolle-Juttner F . Comparison of two preoperative indices to predict perioperative mortality in non-cardiac thoracic surgery. Eur J Cardiothorac Surg. 1997; 11(4):670-5. DOI: 10.1016/s1010-7940(97)01150-0. View

Rejeski W, Rushing J, Guralnik J, Ip E, King A, Manini T . The MAT-sf: identifying risk for major mobility disability. J Gerontol A Biol Sci Med Sci. 2015; 70(5):641-6. PMC: 4447779. DOI: 10.1093/gerona/glv003. View

Allman R, Baker P, Maisiak R, Sims R, Roseman J . Racial similarities and differences in predictors of mobility change over eighteen months. J Gen Intern Med. 2004; 19(11):1118-26. PMC: 1494786. DOI: 10.1111/j.1525-1497.2004.30239.x. View

Afilalo J, Eisenberg M, Morin J, Bergman H, Monette J, Noiseux N . Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010; 56(20):1668-76. DOI: 10.1016/j.jacc.2010.06.039. View

Eggermont L, Gavett B, Volkers K, Blankevoort C, Scherder E, Jefferson A . Lower-extremity function in cognitively healthy aging, mild cognitive impairment, and Alzheimer's disease. Arch Phys Med Rehabil. 2010; 91(4):584-8. PMC: 2864645. DOI: 10.1016/j.apmr.2009.11.020. View

10.

Jencks S, Williams M, Coleman E . Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009; 360(14):1418-28. DOI: 10.1056/NEJMsa0803563. View

11.

Holtzer R, Wang C, Lipton R, Verghese J . The protective effects of executive functions and episodic memory on gait speed decline in aging defined in the context of cognitive reserve. J Am Geriatr Soc. 2012; 60(11):2093-8. PMC: 3498524. DOI: 10.1111/j.1532-5415.2012.04193.x. View

12.

Wolters U, Wolf T, Stutzer H, Schroder T . ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996; 77(2):217-22. DOI: 10.1093/bja/77.2.217. View

13.

Brown C, Flood K . Mobility limitation in the older patient: a clinical review. JAMA. 2013; 310(11):1168-77. DOI: 10.1001/jama.2013.276566. View

14.

Eagle K, Vaishnava P, Froehlich J . Perioperative cardiovascular care for patients undergoing noncardiac surgical intervention. JAMA Intern Med. 2015; 175(5):835-9. DOI: 10.1001/jamainternmed.2015.0150. View

15.

Lee T, Marcantonio E, Mangione C, Thomas E, Polanczyk C, Cook E . Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100(10):1043-9. DOI: 10.1161/01.cir.100.10.1043. View

16.

Fried L, Guralnik J . Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc. 1997; 45(1):92-100. DOI: 10.1111/j.1532-5415.1997.tb00986.x. View

17.

Zakriya K, Christmas C, Wenz Sr J, Franckowiak S, Anderson R, Sieber F . Preoperative factors associated with postoperative change in confusion assessment method score in hip fracture patients. Anesth Analg. 2002; 94(6):1628-32, table of contents. DOI: 10.1097/00000539-200206000-00050. View

18.

Rejeski W, Ip E, Marsh A, Barnard R . Development and validation of a video-animated tool for assessing mobility. J Gerontol A Biol Sci Med Sci. 2010; 65(6):664-71. PMC: 2869532. DOI: 10.1093/gerona/glq055. View

19.

Fleisher L, Fleischmann K, Auerbach A, Barnason S, Beckman J, Bozkurt B . 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014; 64(22):e77-137. DOI: 10.1016/j.jacc.2014.07.944. View

20.

Bilimoria K, Liu Y, Paruch J, Zhou L, Kmiecik T, Ko C . Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013; 217(5):833-42.e1-3. PMC: 3805776. DOI: 10.1016/j.jamcollsurg.2013.07.385. View