Perceptions of 30-Day Postoperative Function Compared to Quantified Performance: Factors Affecting Perceived Functional Decline in Patients Aged 80 Years and Older.

Abstract

Older adults value maintenance of function as an outcome of surgery which can be evaluated by subjective perception and objective performance. The aims of this study were to explore whether these perceptions correlate with a decline in function as measured by decreased ability to perform activities of daily living (ADLs) and to identify risk factors associated with worsened 30-day postoperative perceived physical function (PPF) in patients aged 80 and older. ACS NSQIP Geriatric Surgery Verification Pilot Program data (2015-2017) were used for patients aged 80 and older. Chi-square tests were used to examine concordance between 30-day outcomes of PPF with quantified performance of ADLs. Multivariable logistic regression models identified risks associated with worsened PPF 30-days postoperatively. 5,464 patients from 16 hospitals were included. Mean age was 85.7 and 63% were female. At 30-days postoperatively, 33% reported functional decline while 28% had worsened quantified ADL performance (K=0.25). 21% of patients without quantified decline reported worsened PPF. Risk factors for worsened PPF were found for patient (e.g. ASA class IV/V (OR 2.2, 95% CI 1.5 3.2)), procedure (e.g. orthopedic (1.7, 1.2 2.4)), and older adult-specific characteristics (e.g. preoperative fall (1.9, 1.2 2.9)). At 30 days post-surgery, there was discordance between quantified ADL performance and PPF in patients aged 80 and older. While assessing ADLs is a common approach to detect functional decline and loss of independence, directly asking patients about their perceived physical function could serve as an additional important method for identifying functional decline, ensuring that the evaluation remains patient-centered.