Long-Term Postoperative Recovery Trajectories Among Older Individuals Undergoing Major Operation.

BACKGROUND

Older individuals undergoing major surgery may experience a prolonged recovery period or even permanent institutionalization. We sought to develop a postoperative recovery trajectory model and identify patients at risk of loss of independence after major surgery.

STUDY

DESIGN

Patients undergoing major surgery were identified using Medicare Standard Analytic Files. Latent class group-based trajectory modeling was used to identify clusters of patients with distinct postoperative recovery patterns. Multivariable regression was performed to predict cluster membership.

RESULTS

Five distinct postoperative recovery trajectories were identified: routine (n = 83,603; 11.7%), slow (n = 403,715; 56.4%), protracted (n = 49,704; 6.9%), chronically dependent (n = 156,881; 21.9%), and loss of independence (n = 21,817; 3.1%). On multivariable analysis, preoperative factors associated with loss of independence included older age (relative risk ratio [RRR] 1.03, 95% CI 1.03 to 1.03), high Charlson Comorbidity Index (RRR 3.30, 95% CI 3.17 to 3.40), minority status (RRR 1.30, 95% CI 1.22 to 1.39), urgent index surgery (RRR 1.31, 95% CI 1.26 to 1.36), and frailty (RRR 3.90, 95% CI 3.66 to 4.16). Postoperative factors associated with loss of independence included major complications (RRR 1.78, 95% CI 1.72 to 1.84), ventilator support during the index admission (RRR 1.90, 95% CI 1.85 to 1.96), and ICU stay (RRR 1.09, 95% CI 1.05 to 1.13). The loss of independence risk model was made available online for broad clinical use ( https://khalil-pawlik-postoperativeindependence-calculator.streamlit.app/ ).

CONCLUSIONS

Patients undergoing major surgery demonstrated distinct patterns of postoperative recovery, with some experiencing a loss of independence. A risk prediction model was developed to help clinicians provide more informed guidance to patients and their families regarding future care needs.