Relationship between preoperative disability and postoperative major outcomes in elderly patients undergoing major abdominal surgery

OBJECTIVE: This study aimed to investigate the relationship between preoperative disability and postoperative outcomes in elderly patients undergoing major abdominal surgery. METHODS: This retrospective study included elderly patients aged 65 years and older who underwent elective major abdominal surgery in our hospital from September 2023 to November 2024, aiming to explore the predictive value of preoperative disability levels for the main postoperative outcomes in this population. Patients were divided into a non-disability group and a disability group according to WHODAS 2.0 scores under an ethics-approved waiver of consent. RESULTS: A total of 436 elderly patients were included, with 87 cases (19.9%) in the non-disability group and 349 cases (80.1%) in the disability group. Baseline characteristics showed significant differences between the two groups in Clavien-Dindo Grade (complications: 2.3% vs. 10.9%, P = 0.013) and age (68.0 vs. 71.0, P = 0.004). Univariable analysis showed that disability (OR = 5.19, 95% CI = 1.23–21.96, P = 0.025), history of radiotherapy (OR = 4.51, 95% CI = 1.12–18.16, P = 0.034), coronary heart disease (OR = 2.21, 95% CI = 1.02–4.78, P = 0.045), preoperative anemia (OR = 3.32, 95% CI = 1.57–6.76, P = 0.002), ASA III + IV grade (OR = 2.14, 95% CI = 1.02–4.50, P = 0.044), and prolonged surgery time (per 30 min: OR = 1.15, 95% CI = 1.04–1.27, P = 0.005) were factors associated with adverse outcomes. Multivariable analysis through three models with stepwise variable adjustment (Model 1: gender, age, BMI, history of radiotherapy, coronary heart disease, preoperative anemia; Model 2: additionally adjusted for surgery time; Model 3: adjusted for ASA classification) consistently showed that preoperative disability was an independent risk factor for adverse outcomes, with adjusted ORs of 4.65 (95% CI = 1.09–19.98, P = 0.038), 4.57 (95% CI = 1.02–19.62, P = 0.041), and 4.54 (95% CI = 1.06–19.52, P = 0.042), respectively. CONCLUSION: Preoperative disability is independently associated with an increased risk of postoperative complications in elderly patients undergoing major abdominal surgery, emphasizing the need to develop personalized perioperative management plans for disabled elderly patients.