TOPLINE:

Among older patients undergoing hepatobiliary-pancreatic surgery, low preoperative grip strength was independently associated with approximately sevenfold higher odds of postoperative loss of independence than normal grip strength.

METHODOLOGY:

• Preoperative assessment for predicting surgical outcomes and loss of independence after hepatobiliary-pancreatic surgery among older adult patients is essential because clinical outcomes are heavily influenced by risk factors such as sarcopenia and frailty.
• Researchers conducted a retrospective study of 224 older patients aged 70 years or older (61% men) who underwent hepatobiliary-pancreatic surgery for malignant tumors at a hospital in Japan to evaluate whether preoperative grip strength was associated with surgical outcomes and postoperative loss of independence.
• Participants underwent preoperative grip strength testing and were categorized as having low or normal grip strength based on validated criteria.
• Frailty was also assessed before surgery using a self-administered 15-item checklist questionnaire covering health condition, mental health, eating habits, oral function, weight loss, exercise and falling, cognitive function, smoking, social participation, and social support.
• Loss of independence was defined as postoperative transfer for rehabilitation, readmission, mortality within 6 months, a new need for long-term healthcare support, or an increased level of care within 6 months postoperatively.

TAKEAWAY:

• Overall, 21.9% of patients had low grip strength and 78.1% had normal grip strength; patients with low grip strength were significantly older and had poorer nutritional status than those with normal grip strength (P < .001 for both).
• Patients with low grip strength had significantly longer postoperative hospital stays (19 days vs 14 days; P = .033) and higher complication rates (61% vs 39%; P = .009) than those with normal grip strength.
• Rates of postoperative loss of independence were significantly higher among patients with low vs normal grip strength (P < .001); after multivariable adjustment, low grip strength was associated with approximately sevenfold higher odds of postoperative loss of independence (odds ratio, 7.24; P < .001).
• Patients with low grip strength had significantly higher rates of falls (28.6% vs 9.7%; P = .002) and reduced frequency of going out (18.4% vs 5.7%; P = .009) than those with normal grip strength.

IN PRACTICE:

“[The study] findings suggest that preoperative grip strength may be a novel and simple screening tool for predicting potential outcomes in patients undergoing HBP [hepatobiliary-pancreatic] surgery. Frailty checks can be used to understand the health status of older individuals based on their characteristics and allow for consideration of individualized support, potentially making them useful for preoperative evaluations,” the authors of the study wrote.

SOURCE:

The study was led by Mariko Tsukagoshi, MD, Department of General Surgical Science, Gunma University Graduate School of Medicine in Maebashi, Japan. It was published online in the Journal of Gastrointestinal Surgery.

LIMITATIONS:

The relatively small sample size of the study limited the generalizability of the findings. Potential selection bias existed as surgeons often avoided hepatobiliary-pancreatic surgery in older adults with poor health status. As the frailty checklist questionnaire was self-administered, respondents’ cognitive decline may have affected the results.

DISCLOSURES:

Funding information was not explicitly reported in the study. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.