Mehdi Tahiri, MD, Tarifin Sikder, BSc, Geva Maimon, PhD, Shanon Fraser, MD, Simon Bergman, MD, MSc. McGill University
Introduction: Traditionally, postoperative complications are used in the literature as a surgical outcome. However, to date, very few studies have quantified the impact of complications on recovery after abdominal surgery. The objective of this study was to investigate the impact of complications on the recovery rate of elderly patient’s functional status, after elective abdominal surgery.
Methods: The study consisted of a prospective clinical trial. Elderly patients (70 years and older) undergoing elective abdominal surgery, with a length of stay ≥ 2 days, were prospectively enrolled between July 2012 and July 2014. A preoperative (T0) and four postoperative assessments were conducted: at 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after surgery. In addition to patient characteristics and hospital data, thirty day postoperative complications were collected. The primary outcome, lower body strength, was measured at each time point by a validated measure of functional status in this population, the Short Physical Performance Battery (SPPB). The SPPB is composite score of standing balance, gait speed, and ability to rise from a chair; with a minimally clinically significant difference being 0.3 units. We carried out a repeated measure analysis on SPPB values taken at the different time points to test the effect of the presence of complications on the recovery rate of SPPB. The model was adjusted for age, gender, Charlson Comorbidity Index (CCI), body mass index (BMI), type of surgery, nutritional status, and pre-operative SPPB.
Results: 114 patients (65 men and 49 women) were prospectively enrolled. Mean age was 77.6 ± 5.1 years, mean BMI was 28.4 ± 4.5, and the median CCI was 5 (2.0-7.0). Ninety-nine patients (86%) of the patient were well nourished as per their preoperative SGA score, and 33 patients (29%) underwent minor surgery. Forty-tree patients (36.3%) had one or more complications. In the group with complications, 6% of patients had recovered to baseline at T1, 31% at T2, 48% at T3, and 61% at T4. In the group without complications, the percent of patients who recovered to their preoperative SBBP was 24% at T1, 52% at T2, 70% at T3, and 72% at T4. The repeated measure analysis showed that the rate of recovery was 0.4 units per month in the complications group and 0.8 SPPB units per month in those without complications (p-value < 0.01).
Conclusion: This study provides objective evidence that elderly patient who experience postoperative complications recover slower and take longer to return to their baseline functional status. Postoperative complications are often preventable; hence efforts should be made to identify factors that could minimize them.