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GENERAL ARTICLES

Prognostic Significance of Postoperative In-Hospital Complications in Elderly Patients. II. Long-Term Quality of Life

Department of Anesthesia and Perioperative Care, University of California, San Francisco

Address correspondence and reprint requests to Jacqueline M. Leung, MD, University of California, San Francisco, Mount Zion Medical Center, Department of Anesthesia and Perioperative Care, 1600 Divisadero St., Room C-355, San Francisco, CA 94115. Address e-mail to jmleung{at}itsa.ucsf.edu

To determine the impact of nonfatal in-hospital postoperative complications on long-term quality of life and functional status, we studied consecutive patients 70 yr of age who had undergone noncardiac surgery. The association between the occurrence of nonfatal in-hospital postoperative complications and long-term quality of life (measured by the Medical Outcome Study Short form 36) and functional status was determined 2–3 yr after surgery. Independent predictors of quality of life and functional status were measured by multivariate logistic regression. Two-hundred-sixty-four of 353 patients (74.8%) responded to the survey. The mean Medical Outcome Study Short form 36 scores of patients with in-hospital postoperative complications were significantly lower than those without complications in the following domains: physical functioning (42.8 versus 53.9; P = 0.029), general health (52.3 versus 62.3; P = 0.02), and role emotional (45.7 versus 67.9; P = 0.00058). Patients who had postoperative complications were more likely to be dependent in daily living activities. Comparison with age-matched United States population showed that patients with postoperative complications had lower scores in physical functioning (42.8 versus 53.2; P = 0.04), role physical (26.6 versus 45.3; P = 0.0078), role emotional (45.7 versus 63.2; P = 0.025), and mental health (66 versus 74; P = 0.024). By multivariate logistic regression analysis, only a history of diabetes (odds ratios 4.2; 95% confidence interval, 1.7–10.3; P < 0.002 and new hospitalization because of medical reasons (odds ratio, 3.8; 95% confidence interval, 1.6–8.8; P < 0.002) were significant independent predictors of a long-term decrease in quality of life. Adjusting for other clinical factors, in-hospital complications no longer independently predicted changes in functional status. For geriatric patients, the occurrence of postoperative complications does not independently predict long-term quality of life or functional status. The important independent predictors are co-morbid conditions, age, and new hospitalization after discharge.

IMPLICATIONS: In a group of geriatric patients, the occurrence of postoperative complications did not independently predict long-term quality of life or functional status. The important independent predictors were co-morbid conditions, age, and new hospitalization after discharge.