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 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.
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“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.
SOURCE: http://bit.ly/29CErhV and http://bit.ly/2a2yRK7 JAMA
Surgery, online July 13, 2016.
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