Predicting Functional Decline in Geriatric Abdominal Surgery Patients: Unveiling Incidence, Risk Factors, and Innovative Predictive Models in Thailand

Abstract

Objective: Surgery poses significant challenges for older adults, potentially leading to functional decline. This study investigated the incidence and risk factors associated with postoperative functional decline in older adults and developed formulas to predict its occurrence. Materials and Methods: This cohort study analyzed patients aged 60 and over who underwent elective abdominal surgery at a tertiary care center in Thailand. The baseline characteristics including Basic Activities of Daily Living [BADL] and Instrumental Activities of Daily Living [IADL] scores, preoperative laboratory testing and surgery-related data were recorded. Functional status was reassessed one month post-surgery. Results: The study involved 97 participants. One month post-surgery, the incidence of functional decline was 61.9%. The mean BADL and IADL scores in the functional decline group decreased from 92.8 ± 11.3 to 83.5 ± 17.8 and from 4.3 ± 1.3 to 2.3 ± 1.3, respectively (p<0.001). Multivariable logistic regression analysis identified age ≥ 70 years (adjusted OR 3.18, 95% CI 1.11–9.06, p=0.031) and a length of stay > 7 days (adjusted OR 5.03, 95% CI 1.75–14.42, p=0.003) as factors most strongly associated with functional decline. Formulas created using five factors related to decline from univariable analyses effectively predicted its occurrence, with AUCs ranging from 0.766 to 0.814. Conclusion: Over 60% of older adults who underwent abdominal surgery experienced functional decline one month after surgery. The developed formulas can be used to identify patients at risk and help prevent functional decline in this population.