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The impact of postoperative complications on the recovery of elderly surgical patients

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Abstract

Background

While the negative impact of postoperative complications on hospital costs, survival, and cancer recurrence is well known, few studies have quantified the impact of postoperative complications on patient-centered outcomes such as functional status. The objective of this study was to estimate the impact of postoperative complications on recovery of functional status after elective abdominal surgery in elderly patients.

Methods

Elderly patients (70 years and older) undergoing elective abdominal surgery, with a planned length of stay >1 day, were prospectively enrolled between July 2012 and December 2014. The primary outcome was time to recovery to the preoperative functional status measured by the short physical performance battery (SPPB) preoperatively and at 1 week, 1, 3, and 6 months after surgery. The comprehensive complication index was calculated to grade the severity and number of postoperative complications. A Weibull survival model with interval censoring was performed, controlling for age, sex, body mass index (BMI), comorbidities (Charlson comorbidity index−CCI), frailty, presence of cancer, nutritional status, wound class, preoperative functional status, and surgical approach.

Results

Hundred and forty-nine patients (79 men and 70 women) were included in the analysis. Mean age was 77.7 ± 4.9 years, mean BMI was 27.2 ± 5.5 kg/m2, and the median CCI was 3 (IQR 2–6). The mean preoperative SPPB score was 9.62 ± 2.33. A total of 52 patients (34.9 %) experienced one or more postoperative complications, including four mortalities, and a total of 72 complications. The mean comprehensive complication index score for these patients was 25.7 ± 23.8. In the presence of all other variables included in the model, a higher comprehensive complication index score was found to significantly decrease the hazard of recovery (HR 0.96, CI 0.94–0.98, p value = 0.0004) and hence increase the time to recovery.

Conclusion

Following elective abdominal surgery, elderly patients who experience a greater number and more severe postoperative complications take longer to return to their preoperative functional status.

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Funding

This project was supported by the Canadian Institute of Health Research and McGill Surgical Scientist Program.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada

    Mehdi Tahiri, Fadi Hamadani, Shanon A. Fraser & Simon Bergman

  2. Lady Davis Institute for Medical Research, Montreal, Canada

    Mehdi Tahiri, Tarifin Sikder, Geva Maimon, Debby Teasdale, Nadia Sourial & Simon Bergman

  3. St-Mary’s Hospital Center, McGill University, Montreal, Canada

    Tarifin Sikder & Sebastian Demyttenaere

  4. Steinberg-Bernstein Center for Minimally Invasive Surgery, McGill University, Montreal, Canada

    Liane S. Feldman

  5. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA

    Jack Guralnick

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  1. Mehdi Tahiri
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Correspondence to Simon Bergman.

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Disclosures

Dr. Tahiri, Ms. Sikder, Dr. Maimon, Ms. Teasdale, Ms. Sourial, Dr. Fraser, Dr. Demyttenaere, and Dr. Guralnick have no conflicts of interest or financial relationships to disclose. Dr Bergman is a consultant for Baxter and Covidien. Dr. Feldman receives an unrestricted educational Grant from Conmed and the Steinberg-Bernstein Center receives an unrestricted educational Grant from Covidien.

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Tahiri, M., Sikder, T., Maimon, G. et al. The impact of postoperative complications on the recovery of elderly surgical patients. Surg Endosc 30, 1762–1770 (2016). https://doi.org/10.1007/s00464-015-4440-2

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