Loss of independence post-surgery linked to poor outcomes

Surgical Team Working In Operating Theatre (iStock)

For surgery patients over age 65, losing function or mobility or needing more care after surgery is linked to a higher risk of being readmitted to the hospital or dying, according to a new study.

Almost 60 percent of patients lose at least some of their independence after surgery, said lead author Dr. Julia R. Berian of the American College of Surgeons in Chicago, Illinois.

“Because physicians rarely evaluate measures such as function, mobility and discharge destination, such outcomes are not usually discussed,” Berian said.

“It is something that should be tracked post-operatively, and perhaps should be discussed pre-operatively before the decision to operate is made,” she told Reuters Health by email.

The researchers analyzed data on more than 5,000 patients age 65 and older, including information on their function, mobility and living situation before and after having surgery at one of 26 U.S. hospitals. Most often, the patients needed general surgical operations, while vascular and gynecological surgeries were also common.

Being less independent at the time of hospital discharge was more common for older patients, affecting more than 80 percent of those above age 85. Overall, about 3,000 patients lost some independence after surgery, with a change in function, mobility or care needs, or decreased ability to bathe, dress, groom or eat.

About 10 percent of patients were readmitted to the hospital within 30 days. Complications after surgery, preoperative support systems in the home, being less “fit” and experiencing loss of independence after surgery were all associated with a higher risk of readmission.

Within a month of discharge, 69 patients died. Those who experienced loss of independence were more than six times as likely to die as those who did not lose independence, researchers report in JAMA Surgery.

“We cannot establish causal relationships with our data, since it is retrospective in nature,” Berian said.

But loss of independence is an important marker since it is associated with poor outcomes, and in and of itself is a high priority for most people, she said.

“We are not very good at anticipating the support that will be needed for older adults to continue their postoperative recovery at home,” said Dr. Emily Finlayson of the University of California, San Francisco, who co-authored an editorial alongside the results. “Even when we do, family and community resources are too often not available to provide what is needed to help older adults transition back to independence after surgery.”

Patients who can’t perform the tasks of daily living at home, miss meals and medications, become dehydrated or fail to thrive at home may end up back in the hospital, Finlayson told Reuters Health by email.

“Loss of independence is also an indication that patients were frail coming into surgery,” she said. “It is well established that preoperative frailty is associated with an increased risk of complications and death after surgery.”

Improving nutrition, exercising, and preparing for the return home by freezing meals, arranging for family or friends to come and stay, purchasing assist devices like walkers and grip bars and moving sleeping quarters to the first floor can help preserve independence after surgery, she said.