Considering self-reported baseline function and cognition in predicting post-operative complications among older adults.

Abstract

Older adults experience high rates of postoperative complications and poorer outcomes. Current perioperative risk assessments lack specific measures and are too time-consuming for busy surgeons. Using data from the Health and Retirement Study Survey linked with Medicare data, we performed a cross-sectional study, evaluating all adults ≥65 years old who underwent high-risk elective surgery between 1992-2012. Primary exposure variables included self-reported preoperative functional and cognitive abilities using activities of daily living (ADLs), instrumental activities of daily living (IADLs), and a 27-point self-administered test of memory and mental processing. Primary outcome was the development of a serious postoperative complication within 30-days following index operation. Overall, 42% (n=501) developed at least one serious postoperative complication. Patients with moderate (aOR 1.52, 95% CI: 1.14-2.04) and severe (aOR 1.55, 95% CI: 1.00-2.46) baseline functional limitations were at higher risk of serious postoperative complications compared to those with no functional limitation. Cognitive impairment was not associated with serious postoperative complications. Self-reported functional measures may help to quickly identify patients at high-risk for surgical complications and better inform pre-operative discussions including earlier initiation of palliative care services.