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Association between hospital-acquired functional decline and 2-year readmission or mortality after cardiac surgery in older patients: a multicenter, prospective cohort study

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Abstract

Background

Hospital-acquired functional decline (HAFD) is a new predictor of poor prognosis in hospitalized older patients.

Aims

We aimed to assess the impact of HAFD on the prognosis of older cardiac surgical patients 2 years after discharge.

Methods

This multicenter prospective cohort study assessed 293 patients with cardiac disease aged ≥ 65 years who underwent cardiac surgery at 7 Japanese hospitals between June 2017 and June 2018. The primary endpoint was the composite outcome of cardiovascular-related readmission and all-cause mortality 2 years after discharge. HAFD was assessed using the total Short Physical Performance Battery at hospital discharge.

Results

The primary outcome was observed in 17.3% of the 254 included patients, and HAFD was significantly associated with the primary outcome. Female sex (hazard ratio [HR], 2.451; 95% confidence interval [CI] 1.232–4.878; P = 0.011), hemoglobin level (HR, 0.839; 95% CI 0.705–0.997; P = 0.046), preoperative frailty (HR, 2.391; 95% CI 1.029–5.556; P = 0.043), and HAFD (HR, 2.589; 95% CI 1.122–5.976; P = 0.026) were independently associated with the primary outcome. The incidence rate of HAFD was 22%, with female sex (odds ratio [OR], 1.912; 95% CI 1.049–3.485; P = 0.034), chronic obstructive pulmonary disease (OR, 3.958; 95% CI 1.413–11.086; P = 0.009), and the time interval (days) between surgery and the start of ambulation (OR, 1.260, 95% CI 1.057–1.502; P = 0.010) identified as significant factors.

Discussion

HAFD was found to be an independent prognostic determinant of the primary outcome 2 years after discharge.

Conclusion

HAFD prevention should be prioritized in the hospital care of older cardiac surgery patients.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank all the staff members in all the included hospitals, institutes, and universities. This multicentered study was carried out at the Sakakibara Heart Institute of Okayama, Tsuchiya General Hospital, Higashi Takarazuka Satoh Hospital, Tomishiro Central Hospital, Fukuyama Cardiovascular Hospital, Kansai Electronic Power Hospital, Kobe City Medical Center General Hospital, The Cardiovascular Institute, and Juntendo University.

Funding

This work was supported by Japan Society for the Promotion of Science KAKENHI (grant number: 17K01544).

Author information

Author notes

  1. Tomoyuki Morisawa, Masakazu Saitoh, Shota Otsuka, Go Takamura, Masayuki Tahara, Yusuke Ochi, Yo Takahashi, Kentaro Iwata, Keisuke Oura, Koji Sakurada, and Tetsuya Takahashi take responsibility for all aspects of the reliability and freedom from bias of the data presented and its discussed interpretation.

Authors and Affiliations

  1. Faculty of Health Science, Juntendo University, Tokyo, Japan

    Tomoyuki Morisawa, Masakazu Saitoh & Tetsuya Takahashi

  2. Department of Rehabilitation, Nozomi Heart Clinic, Osaka, Japan

    Shota Otsuka & Keisuke Oura

  3. Department of Rehabilitation, Tsuchiya General Hospital, Hiroshima, Japan

    Go Takamura

  4. Department of Physical Therapy, Higashi Takarazuka Satoh Hospital, Hyogo, Japan

    Masayuki Tahara

  5. Department of Rehabilitation, Fukuyama Cardiovascular Hospital, Hiroshima, Japan

    Yusuke Ochi

  6. Department of Rehabilitation, Yuuai Medical Center, Okinawa, Japan

    Yo Takahashi

  7. Department of Rehabilitation, Kobe City Medical Center General Hospital, Hyogo, Japan

    Kentaro Iwata

  8. Department of Rehabilitation, The Cardiovascular Institute, Tokyo, Japan

    Koji Sakurada

  9. Department of Physical Therapy, Juntendo University, 3-2-12 Hongo, Bunkyo-Ku, Ochanomizu Center Building 5F, Tokyo, 113-0033, Japan

    Tomoyuki Morisawa

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Contributions

Conceptualization: TM, MS, TT; data curation: SO, GT, MT, YO, YT, KI, KO; formal analysis: TM, MS; funding acquisition: TM, TT; investigation: TM, SO, GT, MT, YO, YT, KI, KO; methodology: TM, MS, KS, TT; project administration: TM, TT; resources: TM, MS; software: TM, MS; supervision: TT; validation: TM, MS; visualization: TM, MS; writing—original draft: TM, MS, TT; writing—review and editing: all authors.

Corresponding author

Correspondence to Tomoyuki Morisawa.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments and was approved by the ethics committees of Faculty of Health Science of Juntendo University (19-003). Written informed consent was obtained from all patients.

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

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Morisawa, T., Saitoh, M., Otsuka, S. et al. Association between hospital-acquired functional decline and 2-year readmission or mortality after cardiac surgery in older patients: a multicenter, prospective cohort study. Aging Clin Exp Res 35, 649–657 (2023). https://doi.org/10.1007/s40520-022-02335-1

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