Disability after major abdominal surgery

determinants of recovery of walking ability in elderly patients

Lucia Petrucci, Serena Monteleone, Susanna Ricotti, Erica Giromini, Mariangela Gullace, Emilia Ambrosini, Giorgio Ferriero, Elena Dalla Toffola

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Increased life expectancy and improved surgical techniques have led to a sharp rise in healthcare resource consumption by older patients. In these patients early recovery of walking ability after abdominal surgery may shorten length of hospital stay and reduce overall healthcare costs, but it is important to understand what factors determine this recovery.

AIM: To assess preoperative and postoperative determinants of walking ability recovery after major abdominal surgery in older patients.

DESIGN: Prospective observational study.

SETTING: General Surgery Unit.

POPULATION: The study included 327 consecutive older inpatients who underwent major acute-care abdominal surgery.

METHODS: Data on demographic characteristics, diagnosis, comorbidities defined by Charlson Comorbidity Index (CCI), preoperative walking ability, and early postoperative physical deconditioning (PPDS) were gathered. All patients underwent an individually-tailored rehabilitation program. At discharge, pain (by a Visual Analogue Scale, VAS-pain, 0-10), transfers and walking ability were assessed. Number of rehabilitation sessions attended and discharge setting were recorded.

RESULTS: Of 320 patients included in the analysis (7 died), 72% had CCI>5, signifying presence of >1 comorbidities. Before hospitalization, 79% of patients were completely independent in walking at home, 12% needed assistive devices or direct assistance from the caregiver, and 9% were unable to walk. Complex postoperative physical deconditioning was detected in 25%. At discharge, most patients (87%) had achieved their rehabilitative goal and returned home. Only PPDS and VAS-pain were able to predict both walking ability and the discharge setting, PPDS alone showing adequate sensitivity (82%) and specificity (70%).

CONCLUSIONS: PPDS was the sole early postoperative predictor of recovery of walking ability and the discharge setting. Pain therapy might be a key factor influencing the postoperative functional decline. Age and severity of preoperative comorbidities seem not important determinants of functional decline in older surgical patients.

CLINICAL REHABILITATION IMPACT: An early postoperative assessment of physical deconditioning might be able to predict the walking ability at discharge (hence, the discharge setting), in older patients undergoing major surgery.

Original languageEnglish
Pages (from-to)683-689
Number of pages7
JournalEuropean Journal of Physical and Rehabilitation Medicine
Volume54
Issue number5
DOIs
Publication statusPublished - Oct 2018

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Aptitude
Walking
Comorbidity
Rehabilitation
Pain
Length of Stay
Self-Help Devices
Pain Measurement
Life Expectancy
Health Care Costs
Caregivers
Observational Studies
Inpatients
Hospitalization
Demography
Prospective Studies
Delivery of Health Care
Sensitivity and Specificity

Keywords

  • Abdomen/surgery
  • Aged
  • Comorbidity
  • Female
  • Health Care Costs
  • Humans
  • Life Expectancy
  • Male
  • Pain, Postoperative/prevention & control
  • Patient Discharge
  • Postoperative Period
  • Prospective Studies
  • Recovery of Function
  • Walking/physiology

Cite this

Disability after major abdominal surgery : determinants of recovery of walking ability in elderly patients. / Petrucci, Lucia; Monteleone, Serena; Ricotti, Susanna; Giromini, Erica; Gullace, Mariangela; Ambrosini, Emilia; Ferriero, Giorgio; Dalla Toffola, Elena.

In: European Journal of Physical and Rehabilitation Medicine, Vol. 54, No. 5, 10.2018, p. 683-689.

Research output: Contribution to journalArticle

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T1 - Disability after major abdominal surgery

T2 - determinants of recovery of walking ability in elderly patients

AU - Petrucci, Lucia

AU - Monteleone, Serena

AU - Ricotti, Susanna

AU - Giromini, Erica

AU - Gullace, Mariangela

AU - Ambrosini, Emilia

AU - Ferriero, Giorgio

AU - Dalla Toffola, Elena

PY - 2018/10

Y1 - 2018/10

N2 - BACKGROUND: Increased life expectancy and improved surgical techniques have led to a sharp rise in healthcare resource consumption by older patients. In these patients early recovery of walking ability after abdominal surgery may shorten length of hospital stay and reduce overall healthcare costs, but it is important to understand what factors determine this recovery.AIM: To assess preoperative and postoperative determinants of walking ability recovery after major abdominal surgery in older patients.DESIGN: Prospective observational study.SETTING: General Surgery Unit.POPULATION: The study included 327 consecutive older inpatients who underwent major acute-care abdominal surgery.METHODS: Data on demographic characteristics, diagnosis, comorbidities defined by Charlson Comorbidity Index (CCI), preoperative walking ability, and early postoperative physical deconditioning (PPDS) were gathered. All patients underwent an individually-tailored rehabilitation program. At discharge, pain (by a Visual Analogue Scale, VAS-pain, 0-10), transfers and walking ability were assessed. Number of rehabilitation sessions attended and discharge setting were recorded.RESULTS: Of 320 patients included in the analysis (7 died), 72% had CCI>5, signifying presence of >1 comorbidities. Before hospitalization, 79% of patients were completely independent in walking at home, 12% needed assistive devices or direct assistance from the caregiver, and 9% were unable to walk. Complex postoperative physical deconditioning was detected in 25%. At discharge, most patients (87%) had achieved their rehabilitative goal and returned home. Only PPDS and VAS-pain were able to predict both walking ability and the discharge setting, PPDS alone showing adequate sensitivity (82%) and specificity (70%).CONCLUSIONS: PPDS was the sole early postoperative predictor of recovery of walking ability and the discharge setting. Pain therapy might be a key factor influencing the postoperative functional decline. Age and severity of preoperative comorbidities seem not important determinants of functional decline in older surgical patients.CLINICAL REHABILITATION IMPACT: An early postoperative assessment of physical deconditioning might be able to predict the walking ability at discharge (hence, the discharge setting), in older patients undergoing major surgery.

AB - BACKGROUND: Increased life expectancy and improved surgical techniques have led to a sharp rise in healthcare resource consumption by older patients. In these patients early recovery of walking ability after abdominal surgery may shorten length of hospital stay and reduce overall healthcare costs, but it is important to understand what factors determine this recovery.AIM: To assess preoperative and postoperative determinants of walking ability recovery after major abdominal surgery in older patients.DESIGN: Prospective observational study.SETTING: General Surgery Unit.POPULATION: The study included 327 consecutive older inpatients who underwent major acute-care abdominal surgery.METHODS: Data on demographic characteristics, diagnosis, comorbidities defined by Charlson Comorbidity Index (CCI), preoperative walking ability, and early postoperative physical deconditioning (PPDS) were gathered. All patients underwent an individually-tailored rehabilitation program. At discharge, pain (by a Visual Analogue Scale, VAS-pain, 0-10), transfers and walking ability were assessed. Number of rehabilitation sessions attended and discharge setting were recorded.RESULTS: Of 320 patients included in the analysis (7 died), 72% had CCI>5, signifying presence of >1 comorbidities. Before hospitalization, 79% of patients were completely independent in walking at home, 12% needed assistive devices or direct assistance from the caregiver, and 9% were unable to walk. Complex postoperative physical deconditioning was detected in 25%. At discharge, most patients (87%) had achieved their rehabilitative goal and returned home. Only PPDS and VAS-pain were able to predict both walking ability and the discharge setting, PPDS alone showing adequate sensitivity (82%) and specificity (70%).CONCLUSIONS: PPDS was the sole early postoperative predictor of recovery of walking ability and the discharge setting. Pain therapy might be a key factor influencing the postoperative functional decline. Age and severity of preoperative comorbidities seem not important determinants of functional decline in older surgical patients.CLINICAL REHABILITATION IMPACT: An early postoperative assessment of physical deconditioning might be able to predict the walking ability at discharge (hence, the discharge setting), in older patients undergoing major surgery.

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KW - Aged

KW - Comorbidity

KW - Female

KW - Health Care Costs

KW - Humans

KW - Life Expectancy

KW - Male

KW - Pain, Postoperative/prevention & control

KW - Patient Discharge

KW - Postoperative Period

KW - Prospective Studies

KW - Recovery of Function

KW - Walking/physiology

U2 - 10.23736/S1973-9087.18.04348-4

DO - 10.23736/S1973-9087.18.04348-4

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EP - 689

JO - European Journal of Physical and Rehabilitation Medicine

JF - European Journal of Physical and Rehabilitation Medicine

SN - 1973-9087

IS - 5

ER -