Hospital-Acquired Functional Decline and Clinical Outcomes in Older Cardiac Surgical Patients: A Multicenter Prospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Progression of Postoperative Rehabilitation
2.2. Clinical Outcomes
2.3. Definition of HAFD
2.4. Clinical Characteristics and Measurements of Physical Function
2.5. One-Year Follow-Up Data
Statistical Analysis
3. Results
3.1. Study Population and Incidence of HAFD
3.2. Association between HAFD and the Primary Outcome
3.3. Changes in the Kihon Checklist Score among the HAFD and Non-HAFD Groups
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All (n = 247) | HAFD Group (n = 52) | Non-HAFD Group (n = 195) | p-Value | |
---|---|---|---|---|
Age, years | 74.0 (69, 79) | 75.0 (69, 80) | 75.0 (68, 80) | 0.231 |
Sex, female, % (n) | 38 (95) | 50 (26) | 35 (69) | 0.040 * |
Body mass index, kg/m2 | 23.1 (21.0, 25.3) | 23.1 (19.8, 25.4) | 23.6 (21.8, 25.6) | 0.222 |
NYHA class, % (n) | 0.568 | |||
Class I/ Class II/ Class III/ Class IV | 38 (94)/52 (129)/9 (21)/1 (3) | 44 (23)/46 (24)/10 (5)/0 (0) | 37 (71)/54 (105)/8 (16)/1 (3) | |
LVEF, % | 63 (55, 70) | 64 (55, 71) | 64 (56, 71) | 0.640 |
Comorbidity | ||||
Diabetes mellitus, % (n) | 34 (84) | 44 (23) | 31 (61) | 0.058 |
Chronic kidney disease, % (n) | 22 (55) | 25 (13) | 18 (35) | 0.323 |
Chronic heart failure, % (n) | 39 (95) | 35 (18) | 40 (77) | 0.631 |
Chronic obstructive pulmonary disease, % (%(n) | 6 (14) | 14 (7) | 4 (7) | 0.013 * |
Cerebrovascular disease, % (n) | 15 (32) | 14 (7) | 13 (25) | 0.530 |
Hemoglobin, g/dL | 12.9 (11.6, 14.1) | 12.5 (11.6, 13.6) | 13.3 (11.7, 14.5) | 0.025* |
Albumin, g/dl | 4.0 (3.7, 4.2) | 4.1 (3.8, 4.2) | 4.0 (3.7, 4.2) | 0.787 |
eGFR, ml/min/1.73 m2 | 59.3 (44.3, 70.1) | 56.0 (38.6, 65.9) | 59.3 (45.7, 70.8) | 0.117 |
Preoperative SPPB score, points | 12 (10, 12) | 12 (11, 12) | 12 (11, 12) | 0.199 |
Postoperative SPPB score, points | 12 (10, 12) | 10 (9, 11) | 12 (11, 12) | <0.001 * |
Preoperative gait speed, m/s | 0.98 (0.83, 1.13) | 0.97 (0.82, 1.04) | 1.03 (0.88, 1.16) | 0.152 |
Preoperative grip strength, kg | 23.7 (17.9, 31.0) | 20.2 (16.3, 26.7) | 25.0 (18.5, 32.1) | 0.002 * |
Preoperative frailty, % (n) | 25 (61) | 29 (15) | 24 (46) | 0.470 |
Type of Operation, % (n) | 0.441 | |||
CABG/Valve surgery/ | 26 (64)/32 (80) | 27 (14)/31 (16) | 26 (50)/33 (64) | |
Multiple valve surgery/ | 23 (56) | 17 (9) | 24 (47) | |
CABG + valve surgery | 19 (47) | 25 (13) | 17 (34) | |
Operation time, min | 300 (251, 351) | 288 (245, 332) | 302 (243, 365) | 0.691 |
Bleeding, mL | 570 (320, 1218) | 471 (320, 970) | 610 (260, 1350) | 0.732 |
Length of ICU stay, days | 4.0 (3.0, 5.0) | 4.0 (3.0, 5.0) | 3.0 (2, 4) | 0.142 |
Postoperative day that rehabilitation was started, days | 1.0 (1.0, 1.0) | 1.0 (1.0, 1.0) | 1.0 (1, 1) | 0.370 |
Postoperative day that ambulation was started, days | 3.0 (2.0, 4.0) | 3.0 (2.0, 4.0) | 3.0 (2, 4) | 0.229 |
Postoperative day when ambulation independence was achieved, days | 5.0 (4.0, 6.3) | 5.0 (5.0, 7.0) | 5.0 (4, 7) | 0.180 |
Length of hospital stay, days | 19.0 (16.0, 25.0) | 22.0 (15.0, 27.0) | 19.0 (16, 24) | 0.132 |
Univariate Analysis | Multivariate Analysis | |||||||
---|---|---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |||
Age (every 1-year increase) | 1.035 | 0.989 | 1.084 | 0.137 | 1.027 | 0.975 | 1.082 | 0.317 |
Female | 1.153 | 0.670 | 1.986 | 0.607 | 1.173 | 0.609 | 2.256 | 0.634 |
BMI (every 1-kg/m2 increase) | 0.966 | 0.895 | 1.043 | 0.378 | 1.002 | 0.917 | 1.095 | 0.964 |
NYHA class ≥ III (every degree increase) | 1.529 | 0.648 | 3.610 | 0.333 | ||||
LVEF (every 1% increase) | 0.977 | 0.957 | 0.998 | 0.031 * | 0.982 | 0.959 | 1.005 | 0.129 |
Diabetes mellitus | 1.220 | 0.700 | 2.127 | 0.483 | ||||
CKD | 1.448 | 0.755 | 2.778 | 0.266 | ||||
Hemoglobin | 0.805 | 0.687 | 0.942 | 0.007 * | 0.847 | 0.701 | 1.023 | 0.085 |
Albumin | 0.670 | 0.349 | 1.285 | 0.228 | ||||
Low preoperative gait speed | 2.318 | 1.200 | 4.479 | 0.012 * | 2.477 | 1.185 | 5.176 | 0.016 * |
Low preoperative grip strength | 1.046 | 0.598 | 1.828 | 0.875 | ||||
Preoperative SPPB score | 0.937 | 0.816 | 1.077 | 0.361 | ||||
Bleeding | 1.000 | 1.000 | 1.000 | 0.357 | ||||
Operative time | 1.003 | 1.000 | 1.006 | 0.093 | 1.004 | 1.000 | 1.007 | 0.051 |
Postoperative ICU stay | 1.120 | 0.980 | 1.282 | 0.097 | ||||
Postoperative hospital stay | 0.994 | 0.967 | 1.023 | 0.690 | ||||
Hospital-acquired functional decline | 3.467 | 1.842 | 6.528 | <0.001 ** | 3.437 | 1.756 | 6.729 | <0.001 ** |
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Morisawa, T.; Saitoh, M.; Otsuka, S.; Takamura, G.; Tahara, M.; Ochi, Y.; Takahashi, Y.; Iwata, K.; Oura, K.; Sakurada, K.; et al. Hospital-Acquired Functional Decline and Clinical Outcomes in Older Cardiac Surgical Patients: A Multicenter Prospective Cohort Study. J. Clin. Med. 2022, 11, 640. https://doi.org/10.3390/jcm11030640
Morisawa T, Saitoh M, Otsuka S, Takamura G, Tahara M, Ochi Y, Takahashi Y, Iwata K, Oura K, Sakurada K, et al. Hospital-Acquired Functional Decline and Clinical Outcomes in Older Cardiac Surgical Patients: A Multicenter Prospective Cohort Study. Journal of Clinical Medicine. 2022; 11(3):640. https://doi.org/10.3390/jcm11030640
Chicago/Turabian StyleMorisawa, Tomoyuki, Masakazu Saitoh, Shota Otsuka, Go Takamura, Masayuki Tahara, Yusuke Ochi, Yo Takahashi, Kentaro Iwata, Keisuke Oura, Koji Sakurada, and et al. 2022. "Hospital-Acquired Functional Decline and Clinical Outcomes in Older Cardiac Surgical Patients: A Multicenter Prospective Cohort Study" Journal of Clinical Medicine 11, no. 3: 640. https://doi.org/10.3390/jcm11030640