Impairment in activities of daily living and textbook outcome after major emergency abdominal surgery

PURPOSE: Textbook Outcome (TO) has been a useful tool to assess benchmark patient-centred surgical outcomes in elective abdominal surgery. This study aimed to evaluate the association of preoperative activities of daily living (ADL) status with TOs following major emergency abdominal surgery. METHODS: This retrospective study included 301 consecutive patients who underwent major emergency abdominal surgery for high-risk acute abdominal conditions, including perforated peptic ulcer, intestinal ischemia, bowel obstruction, bowel perforation, and severe intraabdominal bleeding or infection, at Kumamoto Regional Medical Center between April 2019 and March 2025. Preoperative ADL was evaluated using the Barthel Index (range, 0 to 100), with higher scores indicating greater independence. Barthel Index ≤ 85 was defined as ADL impairment. According to a recent international consensus, TO was defined as discharge to "home" without major postoperative complications (Clavien-Dindo grade ≥ III). Multivariable logistic regression analysis was conducted to assess the association of preoperative ADL with TO achievement, adjusting for clinical features and surgery-related factors. RESULTS: Among the 301 patients, 90 (30%) had preoperative ADL impairment (Barthel Index ≤ 85) and 211 (70%) achieved TO. Multivariable analysis revealed that preoperative ADL impairment was independently associated with failure to achieve TO (odds ratio: 0.40; 95% confidence interval: 0.22-0.75; P = 0.004). CONCLUSION: Preoperative ADL impairment is associated with failure to achieve TO after major emergency abdominal surgery. These findings need to be validated by further study to improve patient-centred postoperative outcomes in high-risk abdominal emergencies.