Disability after non-cardiac surgery - patient-centred outcomes and resource utilisation after non-cardiac surgery (PACORUS): a prospective multicentre cohort study.

Abstract

The Standardised Endpoints in Perioperative Medicine Initiative recommends the 12-item WHO Disability Assessment Schedule (WHODAS) 2.0 to measure postoperative functional impairment. However, evidence describing long-term postoperative disability, particularly at 1 year, remains limited. This study aimed to: describe disability up to 1 year after non-cardiac, non-neurosurgical procedures; examine associations between periprocedural risk, postoperative complications and new-onset disability; and evaluate associations between social support, delirium, and frailty and postoperative disability. We conducted a prospective, multicentre cohort study. The primary endpoint was new onset clinically significant disability (an increase in WHODAS 2.0 score ≥ 5% points from baseline to a final score ≥ 35%) or death at 1 year. Independent variables included: periprocedural risk; postoperative complications; frailty; and patient-reported social support. In total, 1081 patients were included: 726 (67%) male, median (IQR) [range] age 67 (60-75 [50-101]) y. New onset clinically significant disability was present in 139/1081 (12.9%) patients at 1 year and in 238/1066 (22.3%) patients at 30 days. Periprocedural risk (adjusted odds ratio (aOR) 1.05, 95%CI 1.03-1.07, per percent in American College of Surgeons National Surgical Quality Improvement Program score) and postoperative complications of all grades were associated with 1-year new onset clinically significant disability. New onset (1 year) clinically significant disability was not associated with social support: OR 0.87, 95%CI 0.54-1.39 for moderate; and OR 0.76, 95%CI 0.47-1.24 for strong social support. Frailty was strongly associated with new onset clinically significant disability after 1 year (aOR 3.97, 95%CI 2.54-6.21). One year after non-cardiac surgery, 13% of surviving patients experienced a new onset clinically significant disability. Postoperative complications, even those of low severity, were associated with new onset postoperative disability.