BACKGROUND: Increased life expectancy and improved surgical techniques have led to a sharp rise in healthcare resource consumption by
older patients. In these patients early recovery of walking ability after abdominal surgery may shorten length of hospital stay and reduce overall
healthcare costs, but it is important to understand what factors determine this recovery.
AIM: To assess preoperative and postoperative determinants of walking ability recovery after major abdominal surgery in older patients.
DESIGN: Prospective observational study.
SETTING: General Surgery Unit.
POPULATIO N: The study included 327 consecutive older inpatients who underwent major acute-care abdominal surgery.
METHODS: Data on demographic characteristics, diagnosis, comorbidities defined by Charlson Comorbidity Index (CCI), preoperative walking
ability, and early postoperative physical deconditioning (PPDS) were gathered. All patients underwent an individually-tailored rehabilitation
program. At discharge, pain (by a Visual Analogue Scale, VAS-pain, 0-10), transfers and walking ability were assessed. Number of rehabilitation
sessions attended and discharge setting were recorded.
RESULTS: Of 320 patients included in the analysis (7 died), 72% had CCI>5, signifying presence of >1 comorbidities. Before hospitalization,
79% of patients were completely independent in walking at home, 12% needed assistive devices or direct assistance from the caregiver, and 9%
were unable to walk. Complex postoperative physical deconditioning was detected in 25%. At discharge, most patients (87%) had achieved their
rehabilitative goal and returned home. Only PPDS and VAS-pain were able to predict both walking ability and the discharge setting, PPDS alone
showing adequate sensitivity (82%) and specificity (70%).
CONCLUSIONS: PPDS was the sole early postoperative predictor of recovery of walking ability and the discharge setting. Pain therapy might
be a key factor influencing the postoperative functional decline. Age and severity of preoperative comorbidities seem not important determinants
of functional decline in older surgical patients.
CLINICAL REHABILITATIO N IMPACT : An early postoperative assessment of physical deconditioning might be able to predict the walking
ability at discharge (hence, the discharge setting), in older patients undergoing major surgery.
(Cite this article as: Petrucci L, Monteleone S, Ricotti S, Giromini E, Gullace M, Ambrosini E, et al. Disability