1 in 5 Elderly Surgical Patients Report Functional Decline Not Quantified Objectively

Ma M, Peters X, Remer S, et al. Perceptions of 30-Day Postoperative Function Compared to Quantified Performance: Factors Affecting Perceived Functional Decline in Patients Aged 80 Years and Older. J Am Coll Surg. 2025; in press.

Patients and surgeons sometimes have conflicting opinions about the postoperative trajectory of recovery. 

Because patient-reported outcomes (PROs) are playing an increasingly important role in surgical quality as a marker for patient-centered care, Meixi Ma, from The University of Alabama at Birmingham and the ACS Clinical Scholars program, and colleagues retrospectively studied the records of 5,464 older patients (≥80 years; mean = 85.7; 63% female) from 16 hospitals who underwent various operations, including orthopaedic procedures (52% of cohort). The data came from the ACS National Surgical Quality Improvement Program Geriatric Surgery Pilot (2015–2017). 

At 30 days postop, 28% of patients had quantified functional decline; however, 33% of patients reported decreased ability to perform activities of daily living. These patients tended to have systemic disease, underwent an orthopaedic procedure, or had another older adult-specific characteristic such as a preoperative fall. Of patients who did not have quantified functional decline, 1-in-5 (21%) reported worsened perceived physical function.

The authors noted that patient-reported outcomes measures may be needed to help understand this gap. “We argue that PROs should be used in conjunction with these validated functional status assessment tools to elicit a complete picture of older adult surgical patient outcomes,” they wrote.