Self-reported Mobility in Older Patients Predicts Early Postoperative Outcomes after Elective Noncardiac Surgery

Abstract

Background Specific geriatric assessment tools may complement traditional perioperative risk stratification. The aim of this study was to evaluate whether self-reported mobility is predictive of postoperative outcomes in older patients undergoing elective noncardiac surgery. Methods Patients aged 69 yr or older (n = 197) underwent (1) traditional risk assessments (American Society of Anesthesiologists physical status classification and Revised Cardiac Risk Index), (2) five-point frailty evaluation, (3) self-reported mobility assessment using the Mobility Assessment Tool–short form (range, 30.21 [poor] to 69.76 [excellent]), and (4) measurements of high-sensitivity C-reactive protein. Outcomes were postoperative complications, time to discharge, and nursing home placement (NHP). Results In the sample of this study (mean age, 75 ± 5 yr; 51% women), 72% had intermediate- or high-risk surgery. Median time to discharge was 3 days (interquartile range, 1 to 4 days). Thirty patients (15%) developed postoperative complications, and 27 (13%) required NHP. After controlling for age, sex, body mass index, pain score, Revised Cardiac Risk Index, American Society of Anesthesiologist physical status, surgical risk, and high-sensitivity C-reactive protein, worse self-reported mobility (per 10-point decrease in Mobility Assessment Tool, which is equivalent to 1 SD) was associated with more postoperative complications (odds ratio [OR], 1.69; 95% CI, 1.05 to 2.73), later time to discharge (hazards ratio, 0.81; 95% CI, 0.68 to 0.96), and increased NHP (OR, 2.01; 95% CI, 1.13 to 3.56). By using the same model, intermediate frailty or frailty increased NHP (OR, 3.11; 95% CI, 1.02 to 9.54) but was not related to either postoperative complications or time to discharge. Conclusions Preoperative self-reported mobility using a novel and brief assessment may help identify elderly patients at risk for adverse postoperative events.

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

“…Indeed, frailty, walking speed, functional dependency, and self-reported diminished mobility or history of falls have all been linked to postoperative complications and mortality in geriatric patients. 44–48 Third, we assessed patients for delirium only once per day, typically around noon, but clinical delirium waxes and wanes throughout the day. Thus, we may have underestimated the incidence of delirium.…”

Self‐Reported Function More Informative than Frailty Phenotype in Predicting Adverse Postoperative Course in Older Adults

“…There are a few other examples directly comparing self‐reported physical status instruments like LLFDI‐FUNCTION with frailty for the purpose of surgical risk stratification. One study found that a video animated tool, the Mobility Assessment Tool, did not significantly improve the ability to predict ACS‐defined serious complication beyond a base model of age, sex, body mass index, pain score, Revised Cardiac Risk index, American Society of Anesthesiology score, and surgical risk . The study population of 197 individuals with low outcome rate (15%) limited their analysis.…”

“…One study found that a video animated tool, the Mobility Assessment Tool, did not significantly improve the ability to predict ACS-defined serious complication beyond a base model of age, sex, body mass index, pain score, Revised Cardiac Risk index, American Society of Anesthesiology score, and surgical risk. 18 The study population of 197 individuals with low outcome rate (15%) limited their analysis. In addition, their base model included multiple other variables and prediction tools that have not been assembled in a common calculator like the ACS Calculator.…”

A Randomized Clinical Trial of Prehabilitation Using Aquatic Exercise in Older Adults with Knee Osteoarthritis Undergoing Total Knee Arthroplasty

“…Our hypothesis was that water exercise would improve preoperative physical function that is known to be a predictor of postoperative outcomes. In the elderly population, preoperative frailty, physical function, preoperative exercise capacity, and mobility are reported to be predictive of surgical outcomes (9,(20)(21)(22)(23)(24). Prehabilitation using exercise is thought to improve postoperative recovery and physiologic reserve by increasing aerobic capacity and muscle strength (25,26).…”

“…A trained study coordinator screened potential participants for baseline mobility status, using the mobility assessment tool-short form (MAT-sf). Those participants who score at or below the 50th percentile, based on our prior preoperative study data (20), were considered eligible (e.g. MAT scores ≤58 for men and ≤50 for women).…”