Postoperative Functional Health Status in Older Adults Undergoing Minor Surgery: An Observational Study

Introduction: Postoperative function is an important patient-centered outcome in older adults. While functional decline is likely in older adults undergoing major surgery, less is known about the functional outcomes of older adults undergoing minor surgery. We aimed to describe the long-term functional outcomes after minor surgery and to examine geriatric-specific risk factors associated with these outcomes.

Methods: We identified subjects who underwent minor surgery while enrolled in the nationally representative Health and Retirement Study (HRS) between 1995-2017 using linked Medicare claims. Using preoperative and postoperative (≥ 6 months) interviews, logistic regression was used to determine risk factors of decline in activities in daily living (ADL) and walking.

Results: Of the 9640 subjects who met inclusion criteria, 45.5% were age 75+ years at the time of surgery and 55.6% female. 2056 subjects (21.3%) experienced a decline in ADL ability, including death. Decline in ADL was more likely for those who were of advanced age (>75 years), non-married, had impaired cognition or dementia, income less than the median, high comorbidity burden, a history of falls, and impaired cognitive strength (P < 0.01 for all comparisons). These factors were also significant for decline in walking ability.

Conclusion: Over 21% of the cohort experienced a decline in functional status (in ADL or walking) or death before their postoperative interview. Preoperative counseling, including anticipatory guidance for postoperative functional decline, should occur with older adult patients undergoing minor surgery.