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

Abstract

Hospital-acquired functional decline (HAFD) is a new predictor of poor prognosis in hospitalized older patients. We aimed to assess the impact of HAFD on the prognosis of older cardiac surgical patients 2years after discharge. This multicenter prospective cohort study assessed 293 patients with cardiac disease aged ≥ 65years 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 2years after discharge. HAFD was assessed using the total Short Physical Performance Battery at hospital discharge. 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. HAFD was found to be an independent prognostic determinant of the primary outcome 2years after discharge. HAFD prevention should be prioritized in the hospital care of older cardiac surgery patients.