Major Elective Surgery Impact on Performance Status in Older Adults: A Prospective Observational Study

Background and Aims: This study evaluated the impact of major elective surgery on performance status, defined as functional and cognitive status, in older adults 3 months postoperatively. Secondary endpoints included assessing the need for domiciliary care, rehospitalization, or institutionalization, and evaluating associations with anesthesia type. Methods: In this observational prospective cohort study, 169 patients aged ≥ 70 underwent major elective surgery between May 2020 and June 2023; 150 had complete information at 3-months (T3). Decline in performance status, either functional or cognitive, was defined as a ≥ 10-point worsening in the Barthel Index (BI) or death, or a ≥ 3-point decline in Mini-Mental State Examination (MMSE), all measured 3 months after surgery. Results: Mean (SD) age was 77 (5) years, with a mean (SD) Charlson Comorbidity Index (CCI) of 7 (2). Most surgeries (133, 79%) were performed for oncologic indications. Baseline median [IQR] BI was 100 [100-100], and MMSE was 27 [25–28]. At T3, 44 (29%) patients showed a ≥ 10-point BI decline (p < 0.001) and 7 died, while 14% exhibited a ≥ 3-point MMSE decrease. Domiciliary care was required in 14 (9%) patients, while 26 (17%) were institutionalized. Fifty-five (37%) patients reported health sequelae within 3 months post-surgery. Multivariable regression analysis associated higher CCI and post-discharge health issues with BI decline or death, but not with MMSE. Domiciliary care needs or rehospitalization was linked to elevated CCI and laparotomic approach. Conclusion: Major elective surgery may compromise functional status in nearly one-third of older patients, especially those with high comorbidity and post-discharge sequelae. Cognitive decline was less prevalent, and the need for domiciliary or institutional care was relatively low. Trial Registration: URL: https://register.clinicaltrials.gov/prs/beta/studies/S000CLIN00000033/recordSummary; Clinicaltrials.gov identifier: NCT05594277.