Skip to main content

Advertisement

SpringerLink
Log in

Postoperative Functional Outcomes in Older Adults

  • Geriatric Surgery (T. Robinson, Section Editor)
  • Published:
Current Surgery Reports Aims and scope Submit manuscript

Abstract

As the world’s aging population grows, the surgical population is increasingly made up of older adults. Due to changes in physiologic function and increasing comorbidity burden, older adults are at increased risk of morbidity, mortality, and functional decline after surgery. In addition, decision to undergo surgery for the older adult may be based on the postoperative functional outcome rather than survival. Although few studies have evaluated an older adult’s function as a postoperative outcome, surgeons are becoming increasingly aware of the importance of maintaining or regaining function in an older patient. Interventions to improve postoperative functional outcomes are being developed and show promising results. This review discusses existing literature on postoperative functional outcomes in older adults and recently developed interventions.

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

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Klopfenstein CE, Herrmann FR, Michel JP, Clerque F, Foster A. The influence of an aging surgical population on the anesthesia workload: a ten-year survey. Anesth Analg. 1998;86(6):1165–70.

    CAS  PubMed  Google Scholar 

  2. Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346(14):1061–6.

    Article  PubMed  Google Scholar 

  3. Atkins J, Naismith SL, Luscombe GM, Hickie IB. Psychological distress and quality of life in older persons: relative contributions of fixed and modifiable risk factors. BMC Psychiatry. 2013;13(1):249. doi:10.1186/1471-244X-13-249.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mohanty S, Liu Y, Paruch JL, Kmiecik TE, Cohen ME, Ko CY, Bilimoria KY. Risk of discharge to postacute care: a patient-centered outcome for the American College of Surgeons National Quality Improvement Program surgical risk calculator. JAMA Surg. 2015;150(5):480–4. doi:10.1001/jamasurg.2014.3176.

    Article  PubMed  Google Scholar 

  5. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9.

    Article  CAS  PubMed  Google Scholar 

  6. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.

    Article  CAS  PubMed  Google Scholar 

  7. Gama EV, Damián J, Pérez del Molino J, López MR, López Pérez M, Gavira Iglesias FJ. Association of individual activities of daily living with self-rated health in older people. Age Ageing. 2000;29(3):267–70.

    Article  CAS  PubMed  Google Scholar 

  8. Finlayson E, Zhao S, Boscardin WJ, Fries BE, Landefeld CS, Dudley RA. Functional status after colon cancer surgery in elderly nursing home residents. J Am Geriatr Soc. 2012;60(5):967–73. doi:10.1111/j.1532-5415.2012.03915.x.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Greer JA, Harvie HS, Andy UU, Smith AL, Northington GM, Arya LA. Short-term postoperative functional outcomes in older women undergoing prolapse surgery. Obstet Gynecol. 2015;125(3):551–8. doi:10.1097/AOG.0000000000000644.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Min L, Mazzurco L, Gure TR, Cigolle CT, Lee P, Bloem C, Malani PN. Longitudinal functional recovery after geriatric cardiac surgery. J Surg Res. 2014;194(1):25–33. doi:10.1016/j.jss.2014.10.043.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ronning B, Wyller TB, Jordhoy MS, Nesbakken A, Bakka A, Seljeflot I, Kristjansson S. Frailty indicators and functional status in older patients after colorectal cancer surgery. J Geriatr Oncol. 2014;5(1):26–32. doi:10.1016/j.jgo.2013.08.001.

    Article  PubMed  Google Scholar 

  12. Amemiya T, Oda K, Ando M, Kawamura T, Kitagawa Y, Okawa Y, Fukata S. Activities of daily living and quality of life of elderly patients after elective surgery for gastric and colorectal cancers. Ann Surg. 2007;246(2):222–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lawrence VA, Hazuda HP, Cornell JE, Pederson T, Bradshaw PT, Mulrow CD, Page CP. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004;199(5):762–72. doi:10.1016/j.jamcollsurg.2004.05.280.

    Article  PubMed  Google Scholar 

  14. Kwon S, Symons R, Yukawa M, Dasher N, Legner V, Flum DR. Evaluating the association of preoperative functional status and postoperative functional decline in older patients undergoing major surgery. Am J Surg. 2012;78(12):1336–44.

    Google Scholar 

  15. Bruce B, Fries JF. The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes. 2003;1:20–6. doi:10.1186/1477-7525-1-20.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Oresanya L, Zhao S, Gan S, Fries BE, Goodney PP, Covinsky KE, Finlayson E. Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study. JAMA Intern Med. 2015;175(6):951–7. doi:10.1001/jamainternmed.2015.0486.

    Article  PubMed  Google Scholar 

  17. Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM. Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med. 2014;174(8):1273–80. doi:10.1001/jamainternmed.2014.2362.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline form the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215(4):453–66. doi:10.1016/j.jamcollsurg.2012.06.017.

    Article  PubMed  Google Scholar 

  19. • Santa Mina D, Clarke H, Ritvo P, Leung YW, Matthew AG, Katz J, Alibhai SMH. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014;100(3):196–207. doi:10.1016/j.physio.2013.08.008. Systematic review and meta-analysis of current literature demonstrating benefit of prehabilitation in the improvement of postoperative functional outcomes for the older surgical patient.

  20. Mayo NE, Feldman L, Scott S, Zavorsky G, Kim DJ, Charlebois P, Carli F. Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery. 2011;150(3):505–14. doi:10.1016/j.surg.2011.07.045.

    Article  PubMed  Google Scholar 

  21. •• Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, Feldman LS. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: A pilot study. Surg Endosc. 2013;27(4):1072–82. Pilot study demonstrating benefit of multimodal prehabilitation in the improvement of functional recovery for geriatric colorectal surgical patients; a randomized controlled trial of the intervention is currently ongoing.

  22. Cohen HJ, Feussner JR, Weinberger M, Carnes M, Hamdy RC, Hsieh F, Lavori P. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med. 2002;346(12):905–12.

    Article  PubMed  Google Scholar 

  23. Inoyue SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM Jr. The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. J Am Geriatr Soc. 2000;48(12):1697–706.

    Article  Google Scholar 

  24. Chen CC, Lin M, Tien Y, Yen C, Huang G, Inouye SK. Modified hospital elder life program: effects on abdominal surgery patients. J Am Coll Surg. 2011;213(2):245–52. doi:10.1016/j.jamcollsurg.2011.05.004.

    Article  PubMed  Google Scholar 

  25. • Bakker FC, Persoon A, Bredie SJH, van Haren-Willems J, Leferink VJ, Noyez L, Olde Rikkert MGM. The CareWell in Hospital program to improve the quality of care for frail elderly inpatients: Results of a before-after study with focus on surgical patients. Am J Surg. 2014; 208(5):735–46. doi:10.1016/j.amjsurg.2014.04.009. Study demonstrating successful improvement in ADLs of geriatric surgical patients 3 months after discharge following implementation of inpatient intervention.

  26. Kong K, Kevorkian CG, Rossi CD. Functional outcomes of patients on a rehabilitation unit after open heart surgery. J Cardpulm Rehabil. 1996;16(6):413–8.

    Article  CAS  Google Scholar 

  27. Hung WW, Ross JS, Farber J, Siu AL. Evaluation of the Mobile Acute Care of the Elderly (MACE) service. JAMA Intern Med. 2013;173(11):990–6. doi:10.1001/jamainternmed.2013.478.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Farber JI, Korc-Grodzicki B, Du Q, Leipzig RM, Siu AL. Operational and quality outcomes of a mobile acute care for the elderly service. J Hosp Med. 2011;6(6):358–63. doi:10.1002/jhm.878.

    Article  PubMed  Google Scholar 

  29. Cronin J, Livhits M, Mercado C, Chen F, Foster N, Chandler C, Chen DC. Quality improvement pilot program for vulnerable elderly surgical patients. Am Surg. 2011;77(10):1305–8.

    PubMed  Google Scholar 

  30. Singh NA, Quine S, Clemson LM, Williams EJ, Williamson DA, Stavrinos TM, Singh MAF. Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. J Am Med Dir Assoc. 2012;13(1):24–30. doi:10.1016/j.jamda.2011.08.005.

    Article  PubMed  Google Scholar 

  31. Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement. Arch Phys Med Rehabil. 2010;91(6):833–9. doi:10.1016/j.apmr.2010.03.002.

    Article  PubMed  Google Scholar 

  32. Harari D, Hopper A, Dhesi J, Babic-Illman G, Lockwood L, Martin F. Proactive care of older people undergoing surgery (‘POPS’): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age Ageing. 2007;36(2):190–6. doi:10.1093/ageing/afl163.

    Article  PubMed  Google Scholar 

  33. Chia CLK, Mantoo SK, Tan KY. ‘Start to finish trans-institutional transdisciplinary care’: a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis. 2016;18(1):43–50. doi:10.1111/codi.13166.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, 505 Parnassus, San Francisco, CA, 94143, USA

    Zabecca S. Brinson & Emily Finlayson

  2. Department of Medicine, 505 Parnassus, San Francisco, CA, 94143, USA

    Victoria L. Tang & Emily Finlayson

  3. Phillip R Lee Institute for Health Policy Studies, 3333 California Street, San Francisco, CA, 94118, USA

    Emily Finlayson

Authors
  1. Zabecca S. Brinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Victoria L. Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily Finlayson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emily Finlayson.

Ethics declarations

Conflict of Interest

Drs Brinson, Tang, and Findlayson declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Geriatric Surgery.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brinson, Z.S., Tang, V.L. & Finlayson, E. Postoperative Functional Outcomes in Older Adults. Curr Surg Rep 4, 21 (2016). https://doi.org/10.1007/s40137-016-0140-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40137-016-0140-7

Keywords

Search

Navigation