Talal F Ali1, Lindsey M Warkentin1, Sayf Gazala1, Adrian S Wagg2, Raj S Padwal2, Rachel G Khadaroo1,3. 1. Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. 2. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 3. Acute Care and Emergency Surgery, University of Alberta, Edmonton, Alberta, Canada.
Abstract
OBJECTIVES: To examine health-related quality of life (HRQL) and cognitive and functional status before and after emergency surgical care in elderly adults. DESIGN: Six-month prospective cohort study. SETTING: Acute care and emergency surgery service at a single, academic tertiary care center, Edmonton, Alberta, Canada. PARTICIPANTS: Admitted individuals aged 65 and older (mean age 77.8 ± 7.9, 52% female) or their surrogates. MEASUREMENTS: Abbreviated Mental Test Score-4 (AMTS), Barthel Index, Vulnerable Elders Survey (VES-13), and EuroQol-5 Dimensional Scale (EQ-5D) completed by participants or their surrogates within 24 hours of admission to the hospital and 6 months after discharge. Paired t-tests and McNemar tests were used to assess the difference between baseline and 6 months. RESULTS: One hundred fifty-five consecutive individuals (including 16 surrogates) were enrolled. Sixteen (10%) died within 6 months of discharge, and 116 (75%, including 18 surrogates) completed a follow-up assessment 6 months after discharge. Cognitive status improved substantially over 6 months, with 72 (52%) of participants having AMTS scores showing cognitive impairment at baseline and four (4%) having AMTS scores showing cognitive impairment at 6 months (P < .001). There was no statistically significant change from baseline on the Barthel Index, VES-13, or EQ-5D. CONCLUSION: There was significant cognitive improvement in older adults after surgical hospitalization. HRQL improved back to age-matched population norms. These results suggest that elderly adults admitted for emergency surgery have good cognitive, functional, and HRQL outcomes.
OBJECTIVES: To examine health-related quality of life (HRQL) and cognitive and functional status before and after emergency surgical care in elderly adults. DESIGN: Six-month prospective cohort study. SETTING: Acute care and emergency surgery service at a single, academic tertiary care center, Edmonton, Alberta, Canada. PARTICIPANTS: Admitted individuals aged 65 and older (mean age 77.8 ± 7.9, 52% female) or their surrogates. MEASUREMENTS: Abbreviated Mental Test Score-4 (AMTS), Barthel Index, Vulnerable Elders Survey (VES-13), and EuroQol-5 Dimensional Scale (EQ-5D) completed by participants or their surrogates within 24 hours of admission to the hospital and 6 months after discharge. Paired t-tests and McNemar tests were used to assess the difference between baseline and 6 months. RESULTS: One hundred fifty-five consecutive individuals (including 16 surrogates) were enrolled. Sixteen (10%) died within 6 months of discharge, and 116 (75%, including 18 surrogates) completed a follow-up assessment 6 months after discharge. Cognitive status improved substantially over 6 months, with 72 (52%) of participants having AMTS scores showing cognitive impairment at baseline and four (4%) having AMTS scores showing cognitive impairment at 6 months (P < .001). There was no statistically significant change from baseline on the Barthel Index, VES-13, or EQ-5D. CONCLUSION: There was significant cognitive improvement in older adults after surgical hospitalization. HRQL improved back to age-matched population norms. These results suggest that elderly adults admitted for emergency surgery have good cognitive, functional, and HRQL outcomes.
Authors: Jinjiao Wang; Mary S Dietrich; Susan P Bell; Cathy A Maxwell; Sandra F Simmons; Sunil Kripalani Journal: BMJ Open Date: 2019-01-29 Impact factor: 2.692