Preoperative physical resilience indicators and their associations with postoperative outcomes

Abstract

The health benefit of surgery in older adults may be outweighed by negative effects on cognitive or physical function. Physical resilience is defined as the potential for recovery after a stressor such as surgery. We assessed associations between physical resilience measured by orthostatic blood pressure (BP) and cerebral oxygenation recovery or grip work (sustained hand grip strength; GW) and postoperative outcome in two cohorts of (older) surgical patients. The first cohort (CTC) consisted of patients undergoing complex cardiothoracic surgery. The second cohort (GRR) held geriatric outpatients undergoing various surgical procedures. Outcome measures were length of stay (LoS) and postoperative complications. Negative binomial (LoS) and ordinal (complications) regression models were used to determine associations. 261 patients (113 CTC and 148 GRR) underwent surgery. Median LoS was 10 (CTC) and 5 days (GRR). Postoperative complications occurred in 80% (CTC) and 45% (GRR) of patients. In CTC, 10 mmHg higher systolic BP recovery was associated with a 12% shorter LoS (incidence rate ratio (IRR) 0.88 (95% CI 0.78-0.98)). 10 s longer sustained hand grip was associated with a 5% shorter LoS in GRR (IRR 0.95 (0.90-1.00)), but a 7% longer LoS in CTC (IRR 1.07 (1.03-1.11)). No significant associations were found with postoperative complications. Orthostatic cerebral oxygenation recovery in CTC was not significantly associated with any postoperative outcome. Our results imply that resilience indicators might be associated with LoS after surgery. Future research should seek to replicate our findings and investigate whether adding resilience parameters to preoperative assessment can support postoperative outcome prediction.

Keywords: Grip strength; Grip work; Orthostatic blood pressure; Postoperative recovery; Resilience.

Fig. 1

Average courses of blood pressure (BP) and heart rate (HR; A + C) and cerebral oxygenation (B) of patients who underwent surgery in different cohorts. A + B: cardiothoracic surgery outpatient clinic (CTC), C: geriatric outpatient clinic (GRR). A + C: systolic BP (SBP) in dark blue, diastolic BP (DBP) in light blue, HR in dashed black. B: oxygenated hemoglobin (O₂Hb) in dark blue, deoxygenated hemoglobin (HHb) in light blue. Courses are shown from 1 min before to 170 s after standing up from a supine (C) or sitting (A + B) position. A grey dotted vertical line indicates the moment of standing up. The mean and standard deviation are shown around 35 s and 55 s after standing up, with a square and line respectively