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HSR&D 2004 National Meeting Abstracts

1038. Predicting Elders' Recovery of Independence After Major Abdominal Surgery
Valerie A Lawrence, MD

Objectives: Patients >/=65 years old undergo >36% of over one million major abdominal operations yearly but evidence about modifiable predictors of recovery of independence is limited.

Methods: Prospective cohort, 372 patients, >/=60 years old, undergoing major elective abdominal operations, assessed preoperatively and postoperatively (1,3,6,12,24 weeks) with self-report and performance-based instruments: Activities of Daily Living(ADL), Instrumental Activities of Daily Living(IADL), Geriatric Depression Scale(GDS), Folstein Mini-Mental State(MMSE), timed walk, functional reach, and hand grip strength. Average recovery time was 12 weeks for ADL and 24 weeks for IADL. We categorized patients as recovered or not recovered at these times to model predictors of recovery (logistic regression) and time to recovery (proportional hazards regression). Recovery did not differ for veterans compared to patients operated at other hospital types on bivariate analysis. Performance-based measures were collinear, so we generated a composite preoperative score with principal components analysis.

Results: Mean age: 69±6 years. Gender: 56% male. Patients’ distribution by hospital type: 49% private, 32% university-affiliated public, 19% university-affiliated Veterans Affairs. Follow-up was 88%. Independent predictors of recovery status in ADL were better preoperative physical status score (Odds Ratio 1.42, 95%CI 1.06-1.90) and serious postoperative complications (0.37, 0.17-0.81). For IADL, predictors were preoperative physical status (1.45, 1.04-2.03), better MMSE (1.18, 1.02-1.34) and GDS (0.91, 0.85-1.01) status, creatinine >1.5mg/dl (0.21, 0.06-0.70) and serious postoperative complications (0.26, 0.10-0.66). Only serious postoperative complications (Hazard Ratio 0.61, 0.42-0.87) predicted time to recovery for ADL, while preoperative physical status (1.2, 1.02-1.41) and GDS (0.95, 0.92-0.98) plus serious postoperative complications (0.61, 0.39-0.96) were predictors for IADL.

Conclusions: Potentially modifiable factors (preoperative physical status and depression, serious postoperative complications) consistently predicted recovery in independence after major abdominal surgery in elders. These results raise the possibility that preoperative interventions to improve function and patient safety may enhance postoperative recovery in elders.