Self-reported Mobility in Older Patients Predicts Early Postoperative Outcomes after Elective Noncardiac Surgery

Abstract

Background: Specific geriatric assessment tools may complement traditional perioperative risk stratification. The aim of this study was to evaluate whether self-reported mobility is predictive of postoperative outcomes in older patients undergoing elective noncardiac surgery.

Methods: Patients aged 69 yr or older (n = 197) underwent (1) traditional risk assessments (American Society of Anesthesiologists physical status classification and Revised Cardiac Risk Index), (2) five-point frailty evaluation, (3) self-reported mobility assessment using the Mobility Assessment Tool-short form (range, 30.21 [poor] to 69.76 [excellent]), and (4) measurements of high-sensitivity C-reactive protein. Outcomes were postoperative complications, time to discharge, and nursing home placement (NHP).

Results: In the sample of this study (mean age, 75 ± 5 yr; 51% women), 72% had intermediate- or high-risk surgery. Median time to discharge was 3 days (interquartile range, 1 to 4 days). Thirty patients (15%) developed postoperative complications, and 27 (13%) required NHP. After controlling for age, sex, body mass index, pain score, Revised Cardiac Risk Index, American Society of Anesthesiologist physical status, surgical risk, and high-sensitivity C-reactive protein, worse self-reported mobility (per 10-point decrease in Mobility Assessment Tool, which is equivalent to 1 SD) was associated with more postoperative complications (odds ratio [OR], 1.69; 95% CI, 1.05 to 2.73), later time to discharge (hazards ratio, 0.81; 95% CI, 0.68 to 0.96), and increased NHP (OR, 2.01; 95% CI, 1.13 to 3.56). By using the same model, intermediate frailty or frailty increased NHP (OR, 3.11; 95% CI, 1.02 to 9.54) but was not related to either postoperative complications or time to discharge.

Conclusions: Preoperative self-reported mobility using a novel and brief assessment may help identify elderly patients at risk for adverse postoperative events.

A) Area under the receiver operating characteristic curve in orthopedic-only patients (n=104) for postoperative complications and B) nursing home placement in models including traditional covariates plus CRP and with either frailty or MAT-sf scores. Traditional covariates included age, sex, body mass index, pain score, Revised Cardiac Risk Index, ASA Physical Status Classification status, and surgical risk. ASA = American Society of Anesthesiologists; CRP = high-sensitivity C-reactive protein; MAT-sf = Mobility Assessment Tool-short form.

Figure 1

Flow of 261 eligible participants who were approached in the preoperative clinic to cohort included in this study.

Figure 2

A) Area under the receiver operating characteristic curve for postoperative complications; and B) nursing home placement in models including traditional covariates plus CRP and with either frailty or MAT-sf scores. Traditional covariates included age, sex, body mass index, pain score, Revised Cardiac Risk Index, ASA Physical Status Classification status, and surgical risk. ASA = American Society of Anesthesiologists; CRP = high-sensitivity C-reactive protein; MAT-sf = Mobility Assessment Tool-short form.