Preoperative factors of hospitalization-associated disability in elderly patients awaiting cardiovascular surgery

Chiaki Shono, Kaoruko Tsukada, Shingo Onozawa, Yoichiro Aoyagi, Makoto Nomura, Takuya Ogino, Yoshiki Enomoto, Tetsuya Miyata, Naoki Sasa, Tomomi Shimizu, Masahiro Fujii, Yuji Wada
Purpose:

To examine the preoperative factors contributing to HAD in elderly patients undergoing elective cardiovascular surgery.

Methods:

Of the 122 patients who underwent standby surgery and perioperative rehabilitation in our cardiovascular surgery department between July 2021 and October 2023, 91 (71 males and 20 females; mean age 74.0 years) were aged 65 years or older. Patients who died were excluded. Patient background factors such as age, sex, medical history, surgical procedure, length of hospital stay, outcome, and preoperative BMI were extracted from medical records. Sarcopenia was assessed according to the AWGS 2019 diagnostic criteria. Physical function was assessed using the Short Physical Performance Battery (SPPB). Swallowing was evaluated on admission using the Eating Assessment Tool-10 (Japanese version), Repetitive Salva Swallowing Test, Modified Water Swallowing Test, and 30mL Water Swallowing Test. HAD was evaluated using the Functional Independence Measure (FIM). We divided the patients into two groups:the HAD groups,  consisting of those whose FIM score at discharge was 5 points or more lower in any sub-item compared to their preoperative FIM score, and the non-HAD group, which included all others.We retrospectively analyzed the outcomes. Factors were compared between the two groups using the unpaired t-test and Χ2 test. A risk rate of less than 5% was used as the significance level. Logistic regression analysis was performed using the factors associated with significant differences. This study was approved by the Ethics Committee of Nippon Medical School Chiba Hokusoh Hospital (ID: H-2023-054).



Results:

There were 20 patients (22%) in the HAD group and 71 (78%) in the non-HAD group. Significant differences were found in sarcopenia, dysphagia, SPPB, length of hospital stay, outcome (P0.05). Stepwise regression analysis identified dysphagia (Odds ratio [OR] 5.5, P0.05) and SPPB (OR 0.63, p0.05) as preoperative factors associated with HAD.

Conclusion(s):

A previous study reported a 21% chance of HAD after cardiovascular surgery, a finding that aligns with our results. Elderly patients with preoperative dysphagia and decreased SPPB should be carefully monitored due to the increased risk of developing postoperative HAD after cardiovascular surgery.


Implications:

The results of this study may allow early identification of elderly patients at risk for developing HAD after cardiovascular surgery. It is crucial to understand the risk of HAD and provide physiotherapy to these patients.


Funding acknowledgements:
This study did not receive any specific funding from any funding agency.
Keywords:
SPPB
HAD
Cardiovascular Surgery
Primary topic:
Cardiorespiratory
Second topic:
Older people
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Nippon Medical School Chiba Hokusoh Hospital Nippon Medical School Chiba Hokusoh Hospital Ethics Committee
Provide the ethics approval number:
H-2023-054
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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