Key result
Moderate or severe postoperative complications were associated with functional decline 30 days after major non-cardiac surgery (OR 1.46; 95% CI 1.02-2.09; p=0.037).
Why the study?
Self-reported postoperative functional recovery is an important patient-centred outcome that is rarely measured or considered in research and decision-making.
What is the incidence and what are the predictors of functional decline after major elective non-cardiac surgery in patients with or at risk of coronary artery disease?
Cohort (n=1,309)
Yes
What is the incidence and what are the predictors of functional decline after major elective non-cardiac surgery in patients with or at risk of coronary artery disease?
Odds Ratio: 1.46 (95% CI 1.02–2.09)
p-value: p=0.037
A significant proportion of patients with or at risk of coronary artery disease experience functional decline up to one year after major non-cardiac surgery, with postoperative complications being a predictor at 30 days.
Postoperative complications may flag short-term functional decline risk after non-cardiac surgery; leaves open whether prevention mitigates decline.
Self-reported postoperative functional recovery is an important patient-centred outcome that is rarely measured or considered in research and decision-making. We conducted a secondary analysis of the measurement of exercise tolerance before surgery (METS) study for associations of peri-operative variables with functional decline after major non-cardiac surgery. Patients who were at least 40 years old, had or were at risk of, coronary artery disease and who were scheduled for non-cardiac surgery were recruited. Primary outcome was a reduction in mobility, self-care or ability to conduct usual activities (EuroQol 5 dimension) from before surgery to 30 days and 1 year after surgery. A decline in at least one function was reported by 523/1309 (40%) participants at 30 days and 320/1309 (24%) participants at 1 year. Participants who reported higher pre-operative Duke Activity Status indices more often reported functional decline 30 days after surgery and less often reported functional decline 1 year after surgery. The odds ratios (95%CI) of functional decline 30 days and 1 year after surgery with moderate or severe postoperative complications were 1.46 (1.02-2.09), p = 0.037 and 1.44 (0.98-2.13), p = 0.066. Discrimination of participants who reported functional decline 30 days and 1 year after surgery were poor (c-statistic 0.61 and 0.63, respectively). In summary, one quarter of participants reported functional decline up to one postoperative year.
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Ladha et al. (2021) conducted a cohort in Major elective non-cardiac surgery (n=1,309). Moderate or severe postoperative complications vs. No or mild postoperative complications was evaluated on Reduction in mobility, self-care or ability to conduct usual activities (EuroQol 5 dimension) from before surgery to 30 days and 1 year after surgery (OR 1.46, 95% CI 1.02-2.09, p=0.037). Moderate or severe postoperative complications were associated with functional decline 30 days after major non-cardiac surgery (OR 1.46; 95% CI 1.02-2.09; p=0.037).
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