ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2018 October;54(5):683-9

DOI: 10.23736/S1973-9087.18.04348-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Disability after major abdominal surgery: determinants of recovery of walking ability in elderly patients

Lucia PETRUCCI ¹, Serena MONTELEONE ², Susanna RICOTTI ¹, Erica GIROMINI ³, Mariangela GULLACE ³, Emilia AMBROSINI ⁴, Giorgio FERRIERO ², Elena DALLA TOFFOLA ³ ✉

¹ Physical Medicine and Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; ² Department of Physical Medicine and Rehabilitation, Scientific Institute of Lissone, IRCCS, Istituti Clinici Scientifici Maugeri, Lissone, Monza-Brianza, Italy; ³ Unit of Physical Medicine and Rehabilitation, Department of Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; ⁴ Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Polytechnic University of Milan, Milan, Italy

BACKGROUND: Increased life expectancy and improved surgical techniques have led to a sharp rise in healthcare resource consumption by older patients. In these patients early recovery of walking ability after abdominal surgery may shorten length of hospital stay and reduce overall healthcare costs, but it is important to understand what factors determine this recovery.
AIM: To assess preoperative and postoperative determinants of walking ability recovery after major abdominal surgery in older patients.
DESIGN: Prospective observational study.
SETTING: General Surgery Unit.
POPULATION: The study included 327 consecutive older inpatients who underwent major acute-care abdominal surgery.
METHODS: Data on demographic characteristics, diagnosis, comorbidities defined by Charlson Comorbidity Index (CCI), preoperative walking ability, and early postoperative physical deconditioning (PPDS) were gathered. All patients underwent an individually-tailored rehabilitation program. At discharge, pain (by a Visual Analogue Scale, VAS-pain, 0-10), transfers and walking ability were assessed. Number of rehabilitation sessions attended and discharge setting were recorded.
RESULTS: Of 320 patients included in the analysis (7 died), 72% had CCI>5, signifying presence of >1 comorbidities. Before hospitalization, 79% of patients were completely independent in walking at home, 12% needed assistive devices or direct assistance from the caregiver, and 9% were unable to walk. Complex postoperative physical deconditioning was detected in 25%. At discharge, most patients (87%) had achieved their rehabilitative goal and returned home. Only PPDS and VAS-pain were able to predict both walking ability and the discharge setting, PPDS alone showing adequate sensitivity (82%) and specificity (70%).
CONCLUSIONS: PPDS was the sole early postoperative predictor of recovery of walking ability and the discharge setting. Pain therapy might be a key factor influencing the postoperative functional decline. Age and severity of preoperative comorbidities seem not important determinants of functional decline in older surgical patients.
CLINICAL REHABILITATION IMPACT: An early postoperative assessment of physical deconditioning might be able to predict the walking ability at discharge (hence, the discharge setting), in older patients undergoing major surgery.

KEY WORDS: Rehabilitation - Length of stay - Comorbidity - Sarcopenia