Atsunori Itagaki1, Masakazu Saitoh2, Daisuke Okamura3, Tomonori Kawamura4, Shota Otsuka5, Masayuki Tahara6, Yuji Mori7, Kenta Kamisaka8, Yusuke Ochi9, Satoshi Yuguchi10, Michitaka Kato11, Tomoyuki Morisawa12, Tetsuya Takahashi13. 1. The Cardiovascular Institute, Tokyo, Japan; Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan. Electronic address: atsunori_itagaki@med.tohoku.ac.jp. 2. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Sakakibara Heart Institute, Tokyo, Japan. 3. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; St. Luke's International Hospital, Tokyo, Japan. 4. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Kishiwada Tokushukai Hospital, Osaka, Japan. 5. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; The Sakakibara Heart Institute of Okayama, Okayama, Japan. 6. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Higashi Takarazuka Satoh Hospital, Hyogo, Japan. 7. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Shizuoka Medical Center, Shizuoka, Japan. 8. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan. 9. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Fukuyama Cardiovascular Hospital, Hiroshima, Japan. 10. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Japan University of Health Sciences, Saitama, Japan. 11. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Tokoha University, Shizuoka, Japan. 12. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Hyogo University of Health Sciences, Hyogo, Japan. 13. Cardiovascular Surgery Physiotherapy Network, Tokyo, Japan; Juntendo University, Tokyo, Japan.
Abstract
BACKGROUND: As few studies have examined physical functioning changes after cardiac surgery, the factors related to the decline in physical functioning remain unclear. This study aimed to investigate the factors related to physical functioning decline after cardiac surgery in older patients. METHODS: The final study sample consisted of 523 older (≥65 years) patients (age 74.2±6.1 years, 66% male) who underwent cardiac surgery at 8 Japanese institutions. We excluded patients who were unable to walk independently or had a slow gait speed (<0.8m/s) before surgery, and those who were unable to regain independent walking after surgery. We divided the patients into two groups, a decline-in-gait-speed group and a non-decline-in-gait-speed group, according to whether their gait speed was less than 0.8m/s at discharge. We analyzed patients' clinical characteristics to identify the factors that predicted the postoperative decline in gait speed. RESULTS: Eighty-nine patients (17.0%) showed a postoperative decline in gait speed. Multivariate logistic regression analysis showed that the following factors predicted a postoperative decline in gait speed: age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.02-1.11]; estimated glomerular filtration rate (OR 0.98, CI 0.96-0.99); preoperative gait speed (OR 0.01, CI 0.00-0.08); and the postoperative day on which the patient could walk independently (OR 1.08, CI 1.02-1.14). CONCLUSIONS: Physical functioning declined in 17% of patients after surgery. The decline could be predicted by several clinical factors, including some that are modifiable. These results suggest that further interventional research on rehabilitation before and after cardiac surgery for older patients might help overcome the decline in physical functioning.
BACKGROUND: As few studies have examined physical functioning changes after cardiac surgery, the factors related to the decline in physical functioning remain unclear. This study aimed to investigate the factors related to physical functioning decline after cardiac surgery in older patients. METHODS: The final study sample consisted of 523 older (≥65 years) patients (age 74.2±6.1 years, 66% male) who underwent cardiac surgery at 8 Japanese institutions. We excluded patients who were unable to walk independently or had a slow gait speed (<0.8m/s) before surgery, and those who were unable to regain independent walking after surgery. We divided the patients into two groups, a decline-in-gait-speed group and a non-decline-in-gait-speed group, according to whether their gait speed was less than 0.8m/s at discharge. We analyzed patients' clinical characteristics to identify the factors that predicted the postoperative decline in gait speed. RESULTS: Eighty-nine patients (17.0%) showed a postoperative decline in gait speed. Multivariate logistic regression analysis showed that the following factors predicted a postoperative decline in gait speed: age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.02-1.11]; estimated glomerular filtration rate (OR 0.98, CI 0.96-0.99); preoperative gait speed (OR 0.01, CI 0.00-0.08); and the postoperative day on which the patient could walk independently (OR 1.08, CI 1.02-1.14). CONCLUSIONS: Physical functioning declined in 17% of patients after surgery. The decline could be predicted by several clinical factors, including some that are modifiable. These results suggest that further interventional research on rehabilitation before and after cardiac surgery for older patients might help overcome the decline in physical functioning.
Authors: Kotaro Hirakawa; Atsuko Nakayama; Masakazu Saitoh; Kentaro Hori; Tomoki Shimokawa; Tomohiro Iwakura; Go Haraguchi; Mitsuaki Isobe Journal: Int J Environ Res Public Health Date: 2022-10-09 Impact factor: 4.614
Authors: Makoto Mori; Mia Djulbegovic; Alexandra M Hajduk; Margaret L Holland; Harlan M Krumholz; Sarwat I Chaudhry Journal: Semin Thorac Cardiovasc Surg Date: 2020-05-19
Authors: Yuji Kanejima; Takayuki Shimogai; Masahiro Kitamura; Kodai Ishihara; Kazuhiro P Izawa Journal: Int J Environ Res Public Health Date: 2020-09-28 Impact factor: 3.390