UCSF

ABSTRACT

Problem: Cardiac surgery is frequently performed in older adults, but little is known

about the quality of recovery (QoR) during the first postoperative month. Older adults are less likely to regain prior functional status by hospital discharge and temporary

postoperative functional loss may become permanent, adversely affecting QoR. Study

aims were to: examine relationships between pain, wound healing, surgical risk,

functional status, mood, quality of life (QoL) and QoR at discharge and 30 days; estimate effects of change over time in functional status, mood and QoL on the change in QoR from discharge to 30 days; describe factors hindering or promoting recovery and the amount of recovery achieved one month after cardiac surgery in older adults.

Methods: In this prospective cohort study, functional status, mood, and QoL were

assessed preoperatively, at discharge, and 30 days postoperatively. Wound healing and

pain were assessed for five days postoperatively and at 30 days. Surgical risk was

assessed preoperatively. QoR was assessed at discharge and 30 days. A one-month

interview assessed promoters and inhibitors of recovery, and percentage of achieved

recovery. Non-parametric correlation and multi-level negative binomial regression were

used for analysis.

Results: Subjects (n = 62) were mostly male (74.2%) with a mean age of 75.9 (SD 7.01). Preoperative functional status, measured with basic activities of daily living (BADL) and intermediate activities of daily living (IADL), correlated with QoR at discharge (rho =.35, .37) and 30 days (n = 59, rho = .46, .27). Preoperative mood and QoL correlated with QoR at 30 days (rho = -.43, .53). Multi-level models showed significant changes between the variables and QoR over time, with the greatest difference in QoR resulting from the change in IADL. Family support was identified as the most important promoter of recovery and mobility limits as the greatest hindrance, while 62% had perceived recovery levels of 75% at 30-days.

Conclusions: Functional status predicts QoR in older cardiac surgery patients. Future

research needs to address methods of improving functional status in the first

postoperative month to improve QoR in older cardiac surgery patients.