FTP5.2 Functional deficits in older patients undergoing major gastrointestinal surgery

Abstract

Abstract Aim Gastrointestinal surgeons face an increasingly complex patient population. Patients are older, often with co-morbidities, frailty, nutritional, functional, and cognitive impairments. The aim of this study was to compare functional outcomes of a cohort of older patients following emergency and elective major gastrointestinal surgery. Methods A prospective cohort study in 3 NHS trusts was performed (NCT04545125). Baseline comprehensive assessment including quality of life, physical activity levels, functional, nutritional, and cognitive status was performed. Functional status (WHODAS v2, & Activities of Daily living questionnaire) and quality of life (EQ-5D-5L) were assessed at baseline, 6 weeks, 3 months, and 6 months following surgery. Results Ninety-eight patients were recruited; median age 74 years, 56% male. Eighty-two patients underwent elective surgery and 16 underwent emergency surgery. At baseline, 13.9% elective vs 68.8% emergency patients were considered vulnerable or frail on frailty testing; 35.9% elective vs 62.5% emergency were identified as malnourished or at risk of malnutrition. Emergency patients had lower Independent Activities of Daily Living score median 6 versus 8 (p=0.007). Baseline activity was lower in emergency patients compared to elective; 1,386 vs 3,882 MET minutes per week (p=0.06). Functional status and quality of life appeared to recover in elective patients by three months, however this was lower at baseline in emergency patients and this persisted over follow-up. Conclusion High levels of baseline functional, cognitive and nutritional deficits were found in this study. Whilst elective patients appear to recover within 3 months, emergency patients have persistent deficits in functional capacity and quality of life.