| dc.description.abstract | Objective: The primary aim of the study is to evaluate the physical function performance differences between those who develop complications and those who do not and determine their impact on recovery. Background: Complication rates in abdominal (colorectal, hernia repair & cholecystectomies) surgery are variable and appear to be lower in minimally invasive, less complex surgery. Complications are associated with significant costs in terms of morbidity, finance, psychological and impact on recovery. Factors that have been identified as associated with complications include age, BMI, surgical approach, co-morbidities, American Society of Anaesthesiologists (ASA) status, physical function frailty and level of dependency. It is also clear that these factors individually are unlikely predictors but highlight the need for multifactorial assessment. Surgical procedures in their essence cause significant physiological stress which can often mimic similar physiological effects of exercise. Cardiopulmonary exercise testing (CPET) can be useful in predicting complications, however is generally unavailable and not always suitable. No one measure has been identified to predict complications in an abdominal surgery population, hence the need to evaluate physical function performance as a whole and analyse differences that may emerge between those who develop complications and those who do not. Methods: Participants were recruited (n = 49) via the pre-operative assessment unit in the University Hospital Limerick. Pre-operative assessment included the following: demographics data, six-minute walk distance, VO2Peak, spirometry, peak cough flow, self-reported activity using the International Physical Activity Questionnaire (IPAQ), ASA score, surgical grade, Malnutrition Universal Scoring Tool (MUST) score, albumin and creatinine levels. Post-surgery data included surgery type, length, surgical approach, initial 24-hour pain relief, length of stay and complications. At 30 and 60 days, participants were contact via telephone and the telephone IPAQ repeated, questioned regarding their self-assessed physical recovery and post hospital discharge complications. Results: Surgery types fell into the following 4 categories: colorectal (n = 21), colorectal reversals (n = 7), hernia repairs (n = 10) and cholecystectomies (n = 5). The complications rate was 41.9% (n=18) pre-discharge, 30.2% (n=13) at 30 day’s post- surgery and 21% (n = 9) at 60 day’s post-surgery. Obesity (P=0.005*), longer operating time (P=0.05*), >2 co-morbidities (P = 0.033*), low activity levels (P=0.020*), low VO2Peak (P=0.017*) and lower 6-minute walk distance (P=0019*) were statistically different between complications and non-complications groups with worse scores seen in the complications group. Length of stay was significantly increased in the complications groups at a median of 8.5 nights versus 2 nights in the non-complications group (P<0.001*). Both the complications and non-complications groups activity levels reduced significantly regardless of the presence of complications and did not return to baseline levels by 60-days post-surgery (P<0.001*). The complications groups also significantly increased their sedentary time from a median of 5 to 7.5 hours daily (P=0.007*). Self-reported physical recovery was almost 100% in the non-complications group at 60 days whilst the complications groups reported a median of feeling approximately 75% recovered. Conclusion: This study highlighted significant differences between groups which are potentially modifiable such as BMI and physical activity and as such warrants further investigation. Regardless of complications, this cohort did not return to or near baseline activity levels and the complications group increased their sedentary activity significantly. If looked at in the larger context of physical activity in the prevention and management of various diseases, could be physically and financially detrimental in the future. | en |
