Background and Goal of Study:The assessment of functional status is critical in health care. The aim of our study was to evaluate the physical status and clinical outcome in surgical elderly.
Materials and Methods:After approval by the institutional ethics committee, an observational prospective study was conducted. Patients aged>60, submitted to elective surgery and admitted to Post Anesthetic Care Unit (PACU) from May to July 2017 were included. The Lawton Instrumental Activities of Daily living scale (IADL) was used to assess dependency on IADL, dependent patients (DP) were considered if at least one activity was affected. Data collection included comorbidities. Comorbidities were quantified using the Charlson Comorbidity Index. Clinical Frailty Scale was used to evaluate vulnerability and frailty patients (FP). The EuroQOL (EQ-5D) was used before surgery (D0) and 3 months later (M3) to evaluate health related quality of life. Preoperative psychological status was analyzed using the Montreal Cognitive Assessment (MOCA) to assess mild cognitive impairment (MCI). Quality of recovery was evaluated with QoR-15 before (D0) and 24h (D1) after surgery. The Mann- Whitney test, Chi-square or Fisher’s exact test were used.
Results and Discussion:Of 235 patients 52% were DP. DP were mainly men (53% vs. 48% p=0.038) and older (median age 72 vs. 67, p<0.001). DP had more frequently chronic kidney disease (p=0.002), Diabetes mellitus (p=0.024), congestive heart failure (p=0.027), ischemic heart disease (p=0.003), arterial hypertension (p<0.001), dyslipidemia (p=0.0031) and peripheral vascular disease (p=0.048). DP were more frequently on b-blockers (p<0.001) and statins (p<0.001). At D0, DP had more problems in all EQ-5D dimensions (p<0.0001 for all dimensions) but anxiety (p=0.067). At M3, DP had more problems in all EQ-5D dimensions (p<0.001 for all dimensions). DP were more frequently frail (p<0.001) at D0 and M3. DP had lower median total scores for qoR-15 at D0 (p<0.001) but not at D1, had more frequently MCI (87% vs. 62%, p<0.001) and higher Charlson score (p<0.001). DP stayed for longer at Hospital (p=0.002).
Conclusion(s):Dependent patients are common among old patients. These patients have more comorbidities and worse quality of life and health status prior surgery and have more frequently MCI and frailty. After surgery, they have similar quality of recovery but at 3 months follow-up they have poor quality of life and are still more frail.

08 / Preoperative dependency and outcome after surgery in elderly patients