BERKELEY, CA (UroToday Inc.) - Dr. Lawrence and colleagues from San Antonio, Texas performed a prospective cohort study to determine how the elderly recover from major abdominal surgery and what variables may predict their outcomes. Their results were published in the November 2004 edition of the Journal of the American College of Surgeons.

They studied 372 patients 60 years or older who underwent elective major intraperitoneal surgery in private practice and university -affiliated settings. Both self-reported and performance-based instruments were used to capture functional recovery at multiple time intervals.

Specific performance based measures included Hand Grip Strength, the Timed Get UP and Go, and Functional Reach. Self-reported measures assessed were the Activities of Daily Living, the Modified Katz Scale and Instrumental Activities of Daily Living. The Mini Mental Status Exam, Geriatric Depression Scale, the Medical Outcomes Study Short Form-36 and Medical Outcomes Study Social Support Survey were also collected. Research associates assessed the patients preoperatively, and then at five intervals postoperatively: 7 to 10 days, 3 weeks, 6 weeks, 3 months, and 6 months.

The mean patient age was 69±6 years, with a distribution of 56% men and 44% women. 49% had surgery in the private hospital setting, while 51% were treated at university-affiliated hospitals. Maximum functional declines occurred 1 week postoperatively, with all parameters reaching their nadir at that time except for grip strength, which worsened at week 3, and SF-36 mental component and the Geriatric Depression Scales, which did not decline.

Recovery duration for each of the instruments was variable. However, most measured variables returned to preoperative status by 6 months except for mean grip strength. Also, substantial numbers of patients had prolonged recoveries, with the greatest number of patients showing delayed recovery in functional reach and grip strength (52 and 58% respectively). Better preoperative physical performance status was a positive predictor of recovery, while serious postoperative complications were a negative predictor. In addition, preoperative depression independently predicted longer recovery times.

The authors concluded that the clinical course of functional recovery varies across different measures, and there are preoperative predictors of recovery, which may be modifiable. Although patients may be able to care for themselves within three months, they may not regain their preoperative strength and endurance until six months.

J Am Coll Surg 2004; 199:762-772