Lillian Min1, Lauren Mazzurco2, Tanya R Gure3, Christine T Cigolle4, Pearl Lee2, Cathie Bloem5, Chiao-Li Chan3, Matthew A Romano5, Brahmajee K Nallamothu6, Kenneth M Langa7, Richard L Prager5, Preeti N Malani8. 1. Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan. Electronic address: lmin@med.umich.edu. 2. Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan. 3. Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan. 4. Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan. 5. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. 6. Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. 7. Division of General Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan. 8. Divisions of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan.
Abstract
BACKGROUND: Impaired functional and cognitive status is an important outcome for older adults undergoing major cardiac surgery. We conducted this pilot study to gauge feasibility of assessing these outcomes longitudinally, from preoperatively up to two time points postoperatively to assess for recovery. METHODS: We interviewed patients aged ≥ 65 y preoperatively and repeated functional and cognitive assessments at 4-6 wk and 4-6 mo postoperatively. Simple unadjusted linear regression was used to test whether baseline measures changed at each follow-up time point. Then we used a longitudinal model to predict postoperative recovery overall, adjusting for comorbidity. RESULTS: A total of 62 patients (age 74.7 ± 5.9) underwent scheduled cardiac surgery. Preoperative activities of daily living (ADL) impairment was associated with poorer functional recovery at 4-6 wk postoperatively with each baseline ADL impairment conferring recovery of 0.5 fewer ADLs (P < 0.05). By 4-6 mo, we could no longer detect a difference in recovery. Preoperative cognition and physical activity were not associated with postoperative changes in these domains. CONCLUSIONS: A preoperative and postoperative evaluation of function and cognition was integrated into the surgical care of older patients. Preoperative impairments in ADLs may be a means to identify patients who might benefit from careful postoperative planning, especially in terms of assistance with self-care during the first 4-6 wk after cardiac surgery. Published by Elsevier Inc.
BACKGROUND: Impaired functional and cognitive status is an important outcome for older adults undergoing major cardiac surgery. We conducted this pilot study to gauge feasibility of assessing these outcomes longitudinally, from preoperatively up to two time points postoperatively to assess for recovery. METHODS: We interviewed patients aged ≥ 65 y preoperatively and repeated functional and cognitive assessments at 4-6 wk and 4-6 mo postoperatively. Simple unadjusted linear regression was used to test whether baseline measures changed at each follow-up time point. Then we used a longitudinal model to predict postoperative recovery overall, adjusting for comorbidity. RESULTS: A total of 62 patients (age 74.7 ± 5.9) underwent scheduled cardiac surgery. Preoperative activities of daily living (ADL) impairment was associated with poorer functional recovery at 4-6 wk postoperatively with each baseline ADL impairment conferring recovery of 0.5 fewer ADLs (P < 0.05). By 4-6 mo, we could no longer detect a difference in recovery. Preoperative cognition and physical activity were not associated with postoperative changes in these domains. CONCLUSIONS: A preoperative and postoperative evaluation of function and cognition was integrated into the surgical care of older patients. Preoperative impairments in ADLs may be a means to identify patients who might benefit from careful postoperative planning, especially in terms of assistance with self-care during the first 4-6 wk after cardiac surgery. Published by Elsevier Inc.
Authors: M F Newman; J L Kirchner; B Phillips-Bute; V Gaver; H Grocott; R H Jones; D B Mark; J G Reves; J A Blumenthal Journal: N Engl J Med Date: 2001-02-08 Impact factor: 91.245
Authors: G Zuccalà; C Cattel; E Manes-Gravina; M G Di Niro; A Cocchi; R Bernabei Journal: J Neurol Neurosurg Psychiatry Date: 1997-10 Impact factor: 10.154
Authors: Jonathan Afilalo; Salvatore Mottillo; Mark J Eisenberg; Karen P Alexander; Nicolas Noiseux; Louis P Perrault; Jean-Francois Morin; Yves Langlois; Samuel M Ohayon; Johanne Monette; Jean-Francois Boivin; David M Shahian; Howard Bergman Journal: Circ Cardiovasc Qual Outcomes Date: 2012-03-06
Authors: K M Langa; M E Chernew; M U Kabeto; A R Herzog; M B Ofstedal; R J Willis; R B Wallace; L M Mucha; W L Straus; A M Fendrick Journal: J Gen Intern Med Date: 2001-11 Impact factor: 5.128
Authors: J Matthew Brennan; Fred H Edwards; Yue Zhao; Sean M O'Brien; Pamela S Douglas; Eric D Peterson Journal: Circulation Date: 2012-08-20 Impact factor: 29.690
Authors: Ashley L Miller; Lillian C Min; Kathleen M Diehl; David C Cron; Chiao-Li Chan; Kyle H Sheetz; Michael N Terjimanian; June A Sullivan; William C Palazzolo; Stewart C Wang; Karen E Hall; Michael J Englesbe Journal: J Surg Res Date: 2014-06-11 Impact factor: 2.192
Authors: Hans F Stabenau; Robert D Becher; Evelyne A Gahbauer; Linda Leo-Summers; Heather G Allore; Thomas M Gill Journal: Ann Surg Date: 2018-12 Impact factor: 12.969
Authors: D Scott Kehler; Andrew N Stammers; Navdeep Tangri; Brett Hiebert; Randy Fransoo; Annette S H Schultz; Kerry Macdonald; Nicholas Giacomontonio; Ansar Hassan; Jean-Francois Légaré; Rakesh C Arora; Todd A Duhamel Journal: BMJ Open Date: 2017-08-11 Impact factor: 2.692
Authors: Jennifer Watt; Andrea C Tricco; Catherine Talbot-Hamon; Ba' Pham; Patricia Rios; Agnes Grudniewicz; Camilla Wong; Douglas Sinclair; Sharon E Straus Journal: BMC Med Date: 2018-01-12 Impact factor: 8.775
Authors: Md Ali Katijjahbe; Linda Denehy; Catherine L Granger; Alistair Royse; Colin Royse; Rebecca Bates; Sarah Logie; Sandy Clarke; Doa El-Ansary Journal: Trials Date: 2017-06-23 Impact factor: 2.279
Authors: Jennifer Watt; Andrea C Tricco; Catherine Talbot-Hamon; Ba' Pham; Patricia Rios; Agnes Grudniewicz; Camilla Wong; Douglas Sinclair; Sharon E Straus Journal: J Gen Intern Med Date: 2018-01-26 Impact factor: 5.128