Risk Factors for Declined Functional Status within 30 days After Elective Surgeries in Elderly Patients: A Prospective Cohort Study

Yudo Murti Mupangati, Henry Setyawan, Czeresna Heriawan Soejono, Muhammad Hussein Gasem, Ignatius Riwanto


Background: Older adults are at risk of decreasing functional status due to their condition and many factors. Although many studies have been conducted about declining in functional status, based on the author’s knowledge, only this study that has conducted about functional status changes in the elderly involving the frailty status which undergoing surgery in Indonesia. There are many factor was postulated, some of that was checked routine and applicable in clinical practice. Furthermore, identification of these risk factors can be used a basis for decision making to perform surgeries in older adults because poor functional status causes declining quality of life in the elderly patients. The aim of this research was to determine the risk factors for declined functional status within 30 days after elective surgeries in elderly patients. Methods: We conducted a prospective cohort study from July 2021 to December 2021 at Dr. Kariadi Hospital, Semarang, Indonesia. We included patients aged 60 or older who underwent elective surgery under general anesthesia. We excluded those who underwent emergency surgery, day care surgery, or were unwillingness to participate. The functional status were assessed using the ADL (Activity of Daily Living) Barthel index. To identify risk factors of  declined ADL scores, a logistic regression analysis was performed on the age variable, gender, body mass index, frailty status, postoperative complications, as well as haemoglobin, and albumin levels. Results: This study included 191 participants, with 97 women (50.79%) and 94 men (42.21%). Declined in functional status within 30-days after surgery occurred in 54 participants (28.2%). There was a significant changed of functional status before and after surgery. Multivariate analysis showed that independently significant variables for declined functional status were male sex (OR 4.48, p value < 0.001), hypoalbuminemia (OR 2.59, p value 0.02), preoperative functional status (OR 2.37; p value 0.05), and postoperative complications (OR 24.885; p value < 0.001). Conclusion: Risk factors for declined functional status within 30 days after elective surgery in older patients are postoperative complications, preoperative functional status, hypoalbuminemia, and male gender.


ADL; Barthel Index; Elderly patients; Surgery


Nichani SS, Grant PJ MPN. Perioperative evaluation and management. In: Halter JB, Ouslander JG, Studenski S, High KP, et al, editor. Hazzard’s geriatric medicine and gerontology. 7th ed. Seventh: New York; 2017. p. 570–84.

BPS BPPN. Proyeksi Penduduk Indonesia 2010-35.

Karakoc D. Surgery of the older patient. Int Surg. 2016;101(3–4):161–6.

Heather Yo, Jeffrey Indes RAR. Surgery in the geriatric patient. In: Townsend, Courtney, Beauchamp R, Evers MMK, editor. Sabiston textbook of surgery. Twentieth. Texas: Elsevier Inc.; 2017. p. 327–59.

Stacie D, H SJ. Long-term outcomes in older surgical patients. Mt Sinai J Med [Internet]. 2012;79(1):95–106. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624763/pdf/nihms412728.pdf

Hartigan I. A comparative review of the Katz ADL and the Barthel Index in assessing the activities of daily living of older people. Int J Older People Nurs. 2007;2(3):204–12.

Kang Y, Zhang GC, Zhu JQ, et al. Activities of daily living associated with postoperative intensive care unit survival in older patients following elective major abdominal surgery: An observational cohort study. Medicine (United States). 2021;100(22):E26056.

Brinson Z, Tang VL, Finlayson E. Postoperative functional outcomes in older adults. Curr Surg Rep. 2016;4(6):21.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

Pan K, Pang S, Robinson M, Goede D, Meenrajan S. A review of perioperative anemia : a modifiable and not so benign risk factor. J Family Med Prim Care [Internet]. 2022;11(2):5004–9. Available from: http://www.jfmpc.com/article.asp?issn=2249-4863;year=2017;volume=6;issue=1;spage=169;epage=170;aulast=Faizi

Amemiya T, Oda K, Ando M, et al. Activities of daily living and quality of life of older patients after elective surgery for gastric and colorectal cancers. Ann Surg. 2007;246(2):222–8.

Kwon S, Symons R, Yukawa M, Dasher N, Legner V, Flum DR. Evaluating the association of preoperative functional status and postoperative functional decline in older patients undergoing major surgery. American Surgeon [Internet]. 2012;78(12):1336–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23265122%5Cnhttp://www.embase.com/search/results?subaction=viewrecord&from=export&id=L366264098%5Cnhttp://docserver.ingentaconnect.com/deliver/connect/sesc/00031348/v78n12/s25.pdf?expires=1355377726&id=71975316&titleid=1

Tang VL, Jing B, Boscardin J, et al. Association on functional, cognitive, and psychological measures with 1-year mortality in patients undergoing major surgery. J Am Med Assoc [Internet]. 2020;67(Supplement 1):S11. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emexa&NEWS=N&AN=627352531

Roedl KJ, Wilson LS, Fine J. A systematic review and comparison of functional assessments of community-dwelling older patients. J Am Assoc Nurse Pract. 2016;28(3):160–9.

Mlinac ME, Feng MC. Assessment of activities of daily living, self-care, and independence. Archives of Clinical Neuropsychology. 2016;31(6):506–16.

Hopman-Rock M, van Hirtum H, de Vreede P, Freiberger E. Activities of daily living in older community-dwelling persons: a systematic review of psychometric properties of instruments. Aging Clin Exp Res [Internet]. 2019;31(7):917–25. Available from: http://dx.doi.org/10.1007/s40520-018-1034-6

Hairi NN, Bulgiba A, Cumming RG, Naganathan V, Mudla I. Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural Malaysia, a middle income country. BMC Public Health. 2010;10.

Torres G de V, dos Reis LA, dos Reis LA. Assessment of functional capacity in older residents of an outlying area in the hinterland of Bahia/Northeast Brazil. Arq Neuropsiquiatr. 2010;68(1):39–43.

Knöferl MW, Angele MK, Diodato MD, et al. Female sex hormones regulate macrophage function after trauma-hemorrhage and prevent increased death rate from subsequent sepsis. Ann Surg. 2002;235(1):105–12.

Trenti A, Tedesco S, Boscaro C, Trevisi L, Bolego C, Cignarella A. Estrogen, angiogenesis, immunity and cell metabolism: Solving the puzzle. Int J Mol Sci. 2018;19(3):1–16.

Veronese N, Siri G, Cella A, et al. Older women are frailer, but less often die then men: a prospective study of older hospitalized people. Maturitas [Internet]. 2019;128(June 2019):81–6. Available from: https://doi.org/10.1016/j.maturitas.2019.07.025

Hsu HY, Hwang LC, Lin CHJ, Lin CHJ, Tjung JJ. Impact of serum albumin on functional status and hospital outcome in oldest-old inpatients. Int J Gerontol [Internet]. 2015;9(4):220–2. Available from: http://dx.doi.org/10.1016/j.ijge.2014.06.008

Pan K, Pang S, Robinson M, Goede D, Meenrajan S. A review of perioperative anemia: A modifiable and not so benign risk factor. J Family Med Prim Care [Internet]. 2022;11:5004–9. Available from: http://www.jfmpc.com/article.asp?issn=2249-4863;year=2017;volume=6;issue=1;spage=169;epage=170;aulast=Faizi

Penninx BWJH, Guralnik JM, Onder G, Ferrucci L, Wallace RB, Pahor M. Anemia and decline in physical performance among older persons. American Journal of Medicine. 2003;115(2):104–10.

Zhang LM, Zhang LM, Hornor MA, et al. Evaluation of postoperative functional health status decline among older adults. JAMA Surg. 2020;155(10):950–8.

Finlayson E, Zhao S, Boscardin J, Fries BE, Landefeld S, Dudley A. Functional status after colon cancer surgery in elder nursing home resident. J Am Geriatr Soc. 2012;60(5):967–73.

Greer JA, Harvie HS, Andy UU, Smith AL, Northington GM, Arya LA. Short-term postoperative functional outcomes in older women undergoing prolapse surgery. Obset Gynecol [Internet]. 2015;125(3):551–538. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958625/pdf/nihms960157.pdf

Larsen PB, Liest S, Hannani D, Jørgensen HL, Sørensen LT, Jørgensen LN. Preoperative hypoalbuminemia predicts early mortality following open abdominal surgery in patients above 60 years of age. Scandinavian Journal of Surgery. 2021;110(1):29–36.

Sivakumar K, Srinivasan G. Impact of serum albumin on functional status and hospital out come of geriatric patients in coimbatore medicalcollege hospital. Journal of Dental and Medical Sciences. 2019;18(8):34–9.

Partridge J, Harari D, Gossage J, Dhesi J. Anaemia in the older surgical patient: A review of prevalence, causes, implications and management. J R Soc Med. 2013;106(7):269–77.

Gregorevic KJ, Hubbard RE, Lim WK, Katz B. The clinical frailty scale predicts functional decline and mortality when used by junior medical staff: A prospective cohort study. BMC Geriatr [Internet]. 2016;16(1):1–6. Available from: http://dx.doi.org/10.1186/s12877-016-0292-4

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