Self-Reported Outcomes in Individuals Aged 65 and Older Admitted for Treatment to an Acute Care Surgical Service: A 6-Month Prospective Cohort Study

Abstract

Objectives: To examine health-related quality of life (HRQL) and cognitive and functional status before and after emergency surgical care in elderly adults.

Design: Six-month prospective cohort study.

Setting: Acute care and emergency surgery service at a single, academic tertiary care center, Edmonton, Alberta, Canada.

Participants: Admitted individuals aged 65 and older (mean age 77.8 ± 7.9, 52% female) or their surrogates.

Measurements: Abbreviated Mental Test Score-4 (AMTS), Barthel Index, Vulnerable Elders Survey (VES-13), and EuroQol-5 Dimensional Scale (EQ-5D) completed by participants or their surrogates within 24 hours of admission to the hospital and 6 months after discharge. Paired t-tests and McNemar tests were used to assess the difference between baseline and 6 months.

Results: One hundred fifty-five consecutive individuals (including 16 surrogates) were enrolled. Sixteen (10%) died within 6 months of discharge, and 116 (75%, including 18 surrogates) completed a follow-up assessment 6 months after discharge. Cognitive status improved substantially over 6 months, with 72 (52%) of participants having AMTS scores showing cognitive impairment at baseline and four (4%) having AMTS scores showing cognitive impairment at 6 months (P < .001). There was no statistically significant change from baseline on the Barthel Index, VES-13, or EQ-5D.

Conclusion: There was significant cognitive improvement in older adults after surgical hospitalization. HRQL improved back to age-matched population norms. These results suggest that elderly adults admitted for emergency surgery have good cognitive, functional, and HRQL outcomes.

Keywords: acute care surgery; elderly; emergency surgery; functional status; health-related quality of life; self-reported outcomes.