Table 5.
Prospective studies of risk factors associated with functional decline among older adults undergoing elective surgery
| Study | Number of patients | Number of patients with functional decline | Time point(s) functional decline measured | Prognostic factors associated with functional decline | Prognostic factors not associated with functional decline | |
|---|---|---|---|---|---|---|
| N | % | |||||
| Amemiya, 2007 [64] | 223 | NR | 24 | 1, 3, and 6 months | POSSUM model (OR 1.19, 95% CI 1.05–1.34), E–PASS model (OR 1.26, 95% CI 1.08–1.47), age (OR 1.10, 95% CI 1.03–1.17) | APACHE II model (OR 1.08, 95% CI 0.97–1.20), male sex (OR 1.72, 95% CI 0.95–3.12), MMSE score (OR 0.95, 95% CI 0.87–1.03), colon cancer (OR 0.89, 95% CI 0.52–1.51) |
| Hoogerduijn, 2014 [69] | 475 | 74 | 16 | 3 months | ISAR-HP: ≥ 65 years (AUC 0.72, 95% CI 0.65–0.79), ≥ 70 years (AUC 0.73, 95% CI 0.66–0.80), ≥ 75 years (AUC 0.75, 95% CI 0.66–0.83) | NR |
| Kwon, 2012 [70] | 204 | 93 | 45.3 | 1, 3, and 12 months | Male sex (OR 3.05, 95% CI 1.41–6.58) at 1 month, ASA score (OR 3.41, 95% CI 1.31–8.86) at 3 months, cancer (OR 2.6, 95% CI 1.14–5.96) at 12 months, smoking status (OR 3.15, 95% CI 1.27–7.85) at 3 months | Age (OR 1.07, 95% CI 0.99–1.15, at 1 month; non-significant all time points), male sex (OR 2.23, 95% CI 0.98–5.08, at 3 months) and (OR 1.17, 95% CI 0.49–2.78, at 12 months), ASA score (OR 1.29, 95% CI 0.58–2.87, at 1 month) and (OR 1.41, 95% CI 0.59–3.34, at 12 months), depression (OR 2.04, 95% CI 0.95–4.36, at 1 month; non-significant all time points), cancer (OR 1.52, 95% CI 0.68–3.39, at 1 month) and (OR 1.29, 95% CI 0.58–2.89, at 3 months), smoking status (OR 1.67, 95% CI 0.79–3.53, at 1 month) and (OR 1.04, 95% CI 0.46–2.36, at 12 months), physical function score – middle tertile (OR 0.68, 95% CI 0.28–1.66, at 1 month; non-significant all time points) |
| Lawrence, 2004 [63] | 372 | 55 | 17 | ADL recovery at 3 months, IADL recovery at 6 months | Physical status (OR 1.42, 95% CI 1.06–1.90, ADL recovery) and (OR 1.45, 95% CI 1.04–2.03, IADL recovery), MMSE score (OR 1.18, 95% CI 1.02–1.34, IADL recovery), GDS (OR 0.91, 95% CI 0.85–0.98, IADL recovery), creatinine > 1.5 mg/dL (OR 0.21, 95% CI 0.06–0.70, IADL recovery), albumin < 3 mg/dL (OR 0.11, 95% CI 0.01–1.22, IADL recovery) | Social support (OR 1.01, 95% CI 1.00–1.02, ADL recovery), MMSE score (OR 1.04, 95% CI 0.92–1.18, ADL recovery), IADL performance (OR 0.96, 95% CI 0.83–1.10, ADL recovery), age (OR 0.97, 95% CI 0.92–1.02, ADL recovery) and (OR 0.99, 95% CI 0.94–1.06, IADL recovery), male sex (OR 0.95, 95% CI 0.38–2.37, IADL recovery), age (OR 0.99, 95% CI 0.94–1.06, IADL recovery) |
| Min, 2015 [65] | 49 | NR | NR | 4–6 weeks | Baseline ADL impairment (P < 0.05), comorbidity (P = 0.03) | Age |
| Pirracchio, 2010 [68] | 90 | NR | NR | 12 months | ADL score at admission (OR 1.67, 95% CI 1.10–2.54), meningioma (vs. others) (OR 3.92, 95% CI 1.43–10.73) | Age (OR 0.95, 95% CI 0.85–1.07), sex (OR 0.83, 95% CI 0.35–1.94), GDS (OR 1.13, 95% CI 0.52–2.45), ASA score (OR 0.55, 95% CI 0.24–1.26), KPS score (OR 1.03, 95% CI 1.03, 95% CI 1.00–1.06), focal deficit (OR 0.52, 95% CI 0.20–1.32) |
ADLs activities of daily living, APACHE II Acute Physiology and Chronic Health Evaluation, ASA American Society of Anesthesiologists, E-PASS Estimation of Physical Ability and Surgical Stress, GDS Geriatric Depression Scale, IADLs instrumental activities of daily living, ISAR-HP Identification of Seniors at Risk-Hospitalized Patients, KPS Karnofsky performance status, MMSE Mini Mental State Exam, POSSUM Physiological and Operative Severity Scoring System, CI confidence interval, AUC area under the curve, N number of patients, OR odds ratio