Skip to main content
SpringerLink
Log in

The association between preoperative fatigue and instrumental activities in daily living with complications and length of hospital stay in patients undergoing colorectal surgery

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

The incidence of colorectal cancer (CRC) is highest among the elderly. An important treatment modality is surgery. After surgery, due to poor functional recovery, some elderly have an increased risk for complications and prolonged length of hospital stay (LOS). Preoperative elevated levels of fatigue and impaired functioning in instrumental activities of daily living (iADL) might be associated with these outcomes, and may, therefore, be helpful to recognize patients with elevated risk for complications or prolonged LOS, who should undergo more thorough functional assessment.

Aims

This exploratory study aims to assess whether physical fatigue, reduced activity and/or iADL, assessed preoperatively, are associated with postoperative complications and prolonged LOS, in elderly patients undergoing surgery for CRC.

Methods

We performed an exploratory prospective study in older (≥ 65 years) patients (n = 57) who were scheduled to undergo elective surgery for colorectal cancer. Fatigue and iADL functioning were assessed with questionnaires. Multivariable regression analyses were used to examine the relationship of fatigue and iADL with complications and LOS.

Results

IADL was not associated with complications or LOS. Fatigue was not associated with complications. Patients with higher fatigue had increased LOS in the univariable analyses but not in the multivariable analyses after adjustment for nutritional status and neoadjuvant treatment.

Discussion

We found that fatigue was associated with increased LOS in the univariable analysis. The results from the multivariable analysis and path analysis indicate, however, that this is likely not a causal relationship; the observed relationship between physical fatigue and LOS appears to be confounded by nutritional status and by having received neoadjuvant treatment.

Conclusions

Although fatigue is a predictor for increased LOS, assessment of fatigue and iADL has no additional value for identifying elderly at risk for poor functional outcome after CRC surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. The Netherlands Cancer Registry (NKR) (2018) https://www.cijfersoverkanker.nl/home-36.html

  2. Benson AB, Venook AP, Al-Hawary MM et al (2018) Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 16(7):874–901. https://doi.org/10.6004/jnccn.2018.0061

    Article  PubMed  Google Scholar 

  3. Benson AB, Venook AP, Cederquist L et al (2018) Colon cancer, version 2.2018. NCCN Clin Pract Guidel Oncol 15:370–398. https://doi.org/10.6004/jnccn.2017.0036

    Article  Google Scholar 

  4. Bertelsen CA, Neuenschwander AU, Jansen JE et al (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet 16:161–168. https://doi.org/10.1016/s1470-2045(14)71168-4

    Article  PubMed  Google Scholar 

  5. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460

    Article  CAS  Google Scholar 

  6. Hamaker ME, Prins MC, Schiphorst AH et al (2015) Long-term changes in physical capacity after colorectal cancer treatment. J Geriatr Oncol 6:153–164. https://doi.org/10.1016/j.jgo.2014.10.001

    Article  PubMed  Google Scholar 

  7. Emily F, Shoujun Z, John BW et al (2012) Functional status after colon cancer surgery in elderly nursing home residents. J Am Geriatr Soc 60:967–973. https://doi.org/10.1111/j.1532-5415.2012.03915.x

    Article  Google Scholar 

  8. Kristjansson SR, Nesbakken A, Jordhøy MS et al (2010) Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: A prospective observational cohort study 76:208–217. https://doi.org/10.1016/j.critrevonc.2009.11.002

    Article  Google Scholar 

  9. Ronning B, Wyller TB, Jordhoy MS et al (2014) Frailty indicators and functional status in older patients after colorectal cancer surgery. J Geriatr Oncol 5:26–32

    Article  Google Scholar 

  10. Tan KY, Kawamura YJ, Tokomitsu A et al (2012) Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg 204:139–143. https://doi.org/10.1016/j.amjsurg.2011.08.012

    Article  PubMed  Google Scholar 

  11. Khuri SF, Henderson WG, DePalma RG et al (2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242:3

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Nathan H, Atoria CL, Bach PB et al (2015) Hospital volume, complications, and cost of cancer surgery in the elderly. J Clin Oncol 33:107–114. https://doi.org/10.1200/JCO.2014.57.7155

    Article  PubMed  Google Scholar 

  14. Ellis G, Whitehead MA, O’Neill D et al (2011) Comprehensive geriatric assessment for older adults admitted to hospital. BMJ. https://doi.org/10.1002/14651858.cd006211.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kristjansson SR, Nesbakken A, Jordhøy MS et al (2010) Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol 76:208–217

    Article  Google Scholar 

  16. Feng MA, McMillan DT, Crowell K et al (2015) Geriatric assessment in surgical oncology: a systematic review. J Surg Res 193:265–272. https://doi.org/10.1016/j.jss.2014.07.004

    Article  PubMed  Google Scholar 

  17. Hamaker ME, Jonker JM, de Rooij SE et al (2012) Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol 13:e444. https://doi.org/10.1016/s1470-2045(12)70259-0

    Article  Google Scholar 

  18. Kristjansson SR, Rønning B, Hurria A et al (2012) A comparison of two pre-operative frailty measures in older surgical cancer patients. J Geriatric Oncol 3:1–7. https://doi.org/10.1016/j.jgo.2011.09.002

    Article  Google Scholar 

  19. Berger AM, Mooney K, Banerjee C et al (2018) Cancer-related fatigue, NCCN clinical practice guidelines in oncology, version 2.2018

  20. Smets EM, Garssen B, Bonke B et al (1995) The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39:315–325

    Article  CAS  Google Scholar 

  21. Heldens A, Bongers BC, Lenssen AF et al (2017) The association between performance parameters of physical fitness and postoperative outcomes in patients undergoing colorectal surgery: an evaluation of care data. Eur J Surg Oncol. https://doi.org/10.1016/j.ejso.2017.08.012

    Article  PubMed  Google Scholar 

  22. Lau KM, Parikh M, Harvey DJ et al (2015) Early cognitively based functional limitations predict loss of independence in instrumental activities of daily living in older adults. J Int Neuropsychol Soc 21:688–698. https://doi.org/10.1017/S1355617715000818

    Article  PubMed  PubMed Central  Google Scholar 

  23. Audisio RA, Gennari R, Sunouchi K et al (2003) Preoperative assessment of cancer in elderly patients: a pilot study. Support Cancer Ther 1:55–60. https://doi.org/10.3816/sct.2003.n.005

    Article  PubMed  Google Scholar 

  24. Kristjansson SR, Jordhøy MS, Nesbakken A et al (2010) Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery? J Geriatr Oncol 1:57–65. https://doi.org/10.1016/j.jgo.2010.06.001

    Article  Google Scholar 

  25. Kothari A, Phillips S, Bretl T et al (2011) Components of geriatric assessments predict thoracic surgery outcomes. J Surg Res 166:5–13. https://doi.org/10.1016/j.jss.2010.05.050

    Article  PubMed  Google Scholar 

  26. Smets EM, Garssen B, Cull A et al (1996) Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. Br J Cancer 73:241–245

    Article  CAS  Google Scholar 

  27. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Article  CAS  Google Scholar 

  28. Edwards MM (1990) The reliability and validity of self-report activities of daily living scales. Can J Occup Ther 57:273–278. https://doi.org/10.1177/000841749005700507

    Article  Google Scholar 

  29. Charlson ME, Pompei P, Ales KL et al (2003) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383. https://doi.org/10.1016/0021-9681(87)90171-8

    Article  Google Scholar 

  30. Roffman CE, Buchanan J, Allison GT (2016) Charlson comorbidities index. J Physiother 62(3):171. https://doi.org/10.1016/j.jphys.2016.05.008

    Article  PubMed  Google Scholar 

  31. Tian Y, Xu B, Yu G et al (2017) Age-adjusted charlson comorbidity index score as predictor of prolonged postoperative ileus in patients with colorectal cancer who underwent surgical resection 8:20794–20801. https://doi.org/10.18632/oncotarget.15285

    Article  Google Scholar 

  32. Krarup PM, Nordholm-Carstensen A, Jorgensen LN et al (2015) Association of comorbidity with anastomotic leak, 30-day mortality, and length of stay in elective surgery for colonic cancer: a nationwide cohort study. Dis Colon Rectum 58:668–676. https://doi.org/10.1097/DCR.0000000000000392

    Article  PubMed  Google Scholar 

  33. Carlomagno N, Santangelo ML, Amato B et al (2014) Total colectomy for cancer: analysis of factors linked to patients’ age. Int J Surg 12(Suppl 2):S139

    Google Scholar 

  34. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  35. Duraes LC, Stocchi L, Steele SR et al (2018) The relationship between Clavien–Dindo morbidity classification and oncologic outcomes after colorectal cancer resection. Ann Surg Oncol 25:188–196

    Article  Google Scholar 

  36. Streiner DL (2005) Finding our way: an introduction to path analysis. Can J Psychiatry 50:115–122. https://doi.org/10.1177/070674370505000207

    Article  PubMed  Google Scholar 

  37. Schumacker RE, Lomax RG (2008) A beginner’s guide to structural equation modeling. Lawrence Erlbaum Associates, Mahway

    Google Scholar 

  38. Hooper D, Coughlan J, Muller MR (2008) Structural equation modelling: guidelines for determining model fit. Electron J Bus Res Methods 6:53–60

    Google Scholar 

  39. Rosseel Y (2012) lavaan: an R package for structural equation modeling. J Stat Softw 48(2). https://doi.org/10.18637/jss.v048.i02

  40. Guinan EM, Doyle SL, Bennett AE et al (2018) Sarcopenia during neoadjuvant therapy for oesophageal cancer: characterising the impact on muscle strength and physical performance. Support Care Cancer 26:1569–1576

    PubMed  Google Scholar 

  41. Fukuse T, Satoda N, Hijiya K et al (2005) Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Chest 127:886–891

    Article  Google Scholar 

  42. Fagard K, Casaer J, Wolthuis A et al (2017) Value of geriatric screening and assessment in predicting postoperative complications in patients older than 70 years undergoing surgery for colorectal cancer. J Geriatr Oncol 8:320–327. https://doi.org/10.1016/j.jgo.2017.07.008

    Article  PubMed  Google Scholar 

  43. Bennedsen ALB, Eriksen JR, Gögenur I (2018) Prolonged hospital stay and readmission rate in an enhanced recovery after surgery cohort undergoing colorectal cancer surgery. Colorectal Dis 20:1097–1108. https://doi.org/10.1111/codi.14446

    Article  CAS  PubMed  Google Scholar 

  44. Samuelsson KS, Egenvall M, Klarin I et al (2019) Preoperative geriatric assessment and follow-up of patients older than 75 years undergoing elective surgery for suspected colorectal cancer. J Geriatr Oncol. https://doi.org/10.1016/j.jgo.2019.01.020

    Article  PubMed  Google Scholar 

  45. Seretis C, Kaisari P, Wanigasooriya K et al (2018) Malnutrition is associated with adverse postoperative outcome in patients undergoing elective colorectal cancer resections. J BUON 23:36–41

    PubMed  Google Scholar 

  46. Biolo G, Cederholm T, Muscaritoli M (2014) Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: from sarcopenic obesity to cachexia. Clin Nutr 33:737–748. https://doi.org/10.1016/j.clnu.2014.03.007

    Article  PubMed  Google Scholar 

  47. Murthy VH, Krumholz HM, Gross CP (2004) Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA 291:2720–2726. https://doi.org/10.1001/jama.291.22.2720

    Article  CAS  PubMed  Google Scholar 

  48. Mokutani Y, Mizushima T, Yamasaki M et al (2016) Prediction of postoperative complications following elective surgery in elderly patients with colorectal cancer using the comprehensive geriatric assessment. Dig Surg 33:470–477

    Article  Google Scholar 

  49. Ghoneim MM, O’Hara MW (2016) Depression and postoperative complications: an overview. BMC Surg 16:5. https://doi.org/10.1186/s12893-016-0120-y

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by the Netherlands Organization for Scientific Research (NWO) under Grant number 023.006.012.

Author information

Authors and Affiliations

  1. University of Applied Sciences Utrecht, Utrecht, The Netherlands

    S. C. Agasi-Idenburg

  2. Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    C. J. A. Punt

  3. Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    N. K. Aaronson

  4. ACHIEVE Center for Applied Research, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands

    M. M. Stuiver

  5. Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    S. C. Agasi-Idenburg & M. M. Stuiver

Authors
  1. S. C. Agasi-Idenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. J. A. Punt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. K. Aaronson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. M. Stuiver
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. C. Agasi-Idenburg.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

Approval for this study was obtained from the Medical Ethical Committee of the Netherlands Cancer Institute. All the procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with 1964 Helsinki Declaration and its later amendments of comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agasi-Idenburg, S.C., Punt, C.J.A., Aaronson, N.K. et al. The association between preoperative fatigue and instrumental activities in daily living with complications and length of hospital stay in patients undergoing colorectal surgery. Aging Clin Exp Res 32, 257–264 (2020). https://doi.org/10.1007/s40520-019-01199-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-019-01199-2

Keywords

Search

Navigation