Functional decline of older patients 1 year after cardiothoracic surgery followed by intensive care admission: a prospective longitudinal cohort study

BACKGROUND: there is a growing demand for cardiothoracic surgery in patients' aged ≥65 years. OBJECTIVE: : to explore which variables were independently associated with functional decline 12 months after cardiothoracic surgery followed by intensive care admission. DESIGN: prospective cohort study. SETTING: cardiothoracic unit of a university teaching hospital. SUBJECTS: a total of 356 elderly patients undergoing cardiothoracic surgery followed by intensive care unit admission. METHODS: functioning was assessed at hospital admission and 3 and 12 months after hospital discharge with the modified Katz activities of daily living (ADL) index. Data collection included demographics, surgical procedure, diagnosis, comorbidities, pre-morbid geriatric conditions and intensive care unit length of stay. Functional decline was defined as a one-point loss on the modified Katz ADL index score at 1 year compared with baseline functioning at hospital admission. Logistic regression analysis was performed to study the association between independent variables and functional decline. RESULTS: the 1-year mortality rate was 8.7% of which 4.8% was in-hospital mortality. The youngest group consisted of 295 patients (64% men; 72 ± 4 years), there were 61 octogenarians (56% men; 82 ± 2 years). One year after hospital discharge, younger patients demonstrated less functional decline (45 versus 56%, P < 0.001). Cognitive impairment, higher age, female gender, alcohol use, type of cardiac procedure and serum creatinine were independently associated with functional decline 1 year after discharge. CONCLUSIONS: the survival rates after cardiothoracic surgery were good, the rates of functional decline were substantial. These results suggest that studies on geriatric rehabilitation before and after surgery might be needed to overcome the decline in functioning.