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Physical frailty recovery is slower than mental frailty recovery after non-cardiac surgery in older adult patients

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Abstract

Purpose

Frailty is characterized by fragility and decline in physical, mental, and social activities; it is commonly observed in older adults. No studies have reported frailty status changes between the preoperative and postoperative periods, including mental and cognitive factors. Therefore, this study investigated frailty factors, including mental and cognitive functions, that change after non-cardiac surgery in older adults.

Methods

Patients aged ≥ 75 years who underwent non-cardiac surgery were surveyed using five tools (Eastern Cooperative Oncology Group-Performance Status (PS); handgrip strengths; Japan-Cardiovascular Health Study index (J-CHS index); Mini-Mental State Examination (MMSE); and Geriatric Depression Scale) for comprehensive evaluation of perioperative functions. The results before surgery, at discharge, and during follow-up at the outpatient clinic were compared.

Results

Fifty-three patients with a median age of 80 (IQR, 77–84) years were evaluated. MMSE scores did not change during the perioperative period. The PS and J-CHS index worsened significantly at discharge and did not improve at the outpatient clinic follow-up. The dominant handgrip strength decreased after surgery (p < 0.001) but improved during follow-up. Additionally, nondominant handgrip strength decreased after surgery (p < 0.001) but did not recover as much as the dominant handgrip strength during follow-up (p = 0.015).

Conclusion

Changes in physical frailty and mental and cognitive functions were not identical perioperatively in older adult patients undergoing non-cardiac surgery. Physical frailty did not improve 1 month after surgery, mental function recovered early, and cognitive function did not decline. This study may be important for frailty prevention in older adult patients.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors express gratitude to Hiroko Shiraki, Hisako Akama, and Minori Oogiyama for their support in the questionnaire survey and data collection.

Author information

Authors and Affiliations

  1. Department of Gastroenterological and General Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan

    Tomokazu Kishiki, Nobuyoshi Aso, Aiko Iioka, Takashi Wakamatsu, Kazuna Honda, Isao Kataoka, Sangchul Kim, Shun Ishii, Satoshi Isobe, Toshiya Shirota, Mayumi Ide, Yoshihiro Sakamoto, Nobutsugu Abe & Eiji Sunami

  2. Department of Geriatric Medicine, Kyorin University School of Medicine, Tokyo, Japan

    Hiroshi Hasegawa

  3. Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan

    Hideaki Yoshino & Seiichi Taniai

  4. Department of Anesthesiology, St John’s Sakuramachi Hospital, Tokyo, Japan

    Kumi Moriyama

  5. Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan

    Tomoko Yorozu

  6. Department of Thoracic and Thyroid Surgery, Kyorin University School of Medicine, Tokyo, Japan

    Haruhiko Kondo

Authors
  1. Tomokazu Kishiki
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  2. Hiroshi Hasegawa
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Contributions

Study conception and design: Tomokazu Kishiki, Hiroshi Hasegawa, Hideaki Yoshino, Seiichi Taniai, Kumi Moriyama, Tomoko Yorozu, Haruhiko Kondo, Yoshihiro Sakamoto, Nobutsugu Abe, and Eiji Sunami; Acquisition of data: Tomokazu Kishiki, Hiroshi Hasegawa, Hideaki Yoshino, Nobuyoshi Aso, Aiko Iioka, Takashi Wakamatsu, Kazuna Honda, Isao Kataoka, Sangchul Kim, Shun Ishii, Satoshi Isobe, Toshiya Shirota, Mayumi Ide, Seiichi Taniai, Kumi Moriyama, Tomoko Yorozu, Haruhiko Kondo, Yoshihiro Sakamoto, Nobutsugu Abe, and Eiji Sunami; Analysis and interpretation of data: Tomokazu Kishiki, Hiroshi Hasegawa, Hideaki Yoshino, Seiichi Taniai, Kumi Moriyama, Tomoko Yorozu, Haruhiko Kondo, Yoshihiro Sakamoto, Nobutsugu Abe, and Eiji Sunami; Drafting of manuscript: Tomokazu Kishiki, Hiroshi Hasegawa, Hideaki Yoshino, Nobuyoshi Aso, Aiko Iioka, Takashi Wakamatsu, Kazuna Honda, Isao Kataoka, Sangchul Kim, Shun Ishii, Satoshi Isobe, Toshiya Shirota, Mayumi Ide, Seiichi Taniai, Kumi Moriyama, Tomoko Yorozu, Haruhiko Kondo, Yoshihiro Sakamoto, Nobutsugu Abe, and Eiji Sunami; Critical revision of manuscript: Tomokazu Kishiki, Hiroshi Hasegawa, Hideaki Yoshino, Nobuyoshi Aso, Aiko Iioka, Takashi Wakamatsu, Kazuna Honda, Isao Kataoka, Sangchul Kim, Shun Ishii, Satoshi Isobe, Toshiya Shirota, Mayumi Ide, Seiichi Taniai, Kumi Moriyama, Tomoko Yorozu, Haruhiko Kondo, Yoshihiro Sakamoto, Nobutsugu Abe, and Eiji Sunami.

Corresponding author

Correspondence to Tomokazu Kishiki.

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Ethics approval

The study was conducted in accordance with the ethical guidelines of the 1975 Declaration of Helsinki. This study protocol was approved by the Research Ethics Committee of Kyorin University Hospital (approval date and number: November 14, 2017, and 1013).

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Written informed consent was obtained from all the participants.

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The authors declare no competing interests.

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Appendix

Appendix

 

ECOG Performance Status

Grade

ECOG

0

Fully active, able to carry on all pre-disease performance without restriction

1

Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work

2

Ambulatory and capable of all self-care actions but unable to carry out any work-related activities. Up and about more than 50% of waking hours

3

Capable of only limited self-care, confined to bed or chair more than 50% of waking hours

4

Completely disabled. Cannot carry on any self-care actions. Totally confined to bed or chair

5

Dead

  1. ECOG Eastern Cooperative Oncology Group-Performance Status

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Kishiki, T., Hasegawa, H., Yoshino, H. et al. Physical frailty recovery is slower than mental frailty recovery after non-cardiac surgery in older adult patients. Langenbecks Arch Surg 408, 395 (2023). https://doi.org/10.1007/s00423-023-03123-9

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