The proposed research is a prospective cohort study of postoperative long- term functional outcome and caregiver burden in elders undergoing major abdominal surgery. Previous studies are limited because they focus on short-term operative risk, the phenomenology of long term recovery after low risk operations for specific physical impairment (e.g., hip fracture repair, hip replacement, cataract surgery) or coronary artery bypass surgery. Further, there has been little attention to identifying interventions to maximize recovery and reduce caregiver burden after major noncardiac surgery.
Specific aims are to 1) map the course of long-term (six months) functional recovery and caregiver burden in elders under going major abdominal surgery, 2) identify important determinants of long-term recovery, 3) evaluate the effect of variation (postoperative changes or variable effects) in important determinants of functional recovery and 4) use qualitative iterative techniques to identify potential interventions to maximize recovery and reduce caregiver burden. Abdominal surgery has been chosen because it is not usually associated with chronic related antecedent functional impairment which will affect expectations for recovery. Primary hypotheses are 1) significant numbers of elders (at least 10%) have protracted postoperative disability for up to six months, 2) physical, cognitive and affective status, medical comorbidity and social support are primary determinants of functional recovery and 3) poorer preoperative functional status for these determinants of independence is associated with worse functional outcome. Subjects who are greater than 60 and without illness which would itself determine recovery (e.g. metastatic cancer) will be recruited from both academic and community site. Subjects will undergo a comprehensive battery of instruments to assess functional independence, preoperatively and postoperatively at one, three and six weeks and three and six months. Caregiver burden and health resource utilization will be evaluated at postoperative follow up visits. Discriminant analysis will be used to evaluate the relationship between preoperative status for primary determinants and postoperative functional independence, defined by Activities of Daily Living and Instrumental Activities of Daily Living. Pooled time series cross-sectional regression analysis will be used to evaluate athe impact of changes in functional determinants on long-term potential interventions to enhance functional outcome, prevent disability and reduce caregiver burden.
| Lawrence, Valerie A; Hazuda, Helen P; Cornell, John E et al. (2004) Functional independence after major abdominal surgery in the elderly. J Am Coll Surg 199:762-72 |
