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Functional Trajectories Before and After Major Surgery in Older Adults

Stabenau, Hans F., MD, PhD*; Becher, Robert D., MD, MS; Gahbauer, Evelyne A., MD, MPH*; Leo-Summers, Linda, MPH*; Allore, Heather G., PhD*; Gill, Thomas M., MD*


Due to an author's error, Figure 1, published in the article “Functional Trajectories Before and After Major Surgery in Older Adults” in the December issue of the journal, contained transposed labels. The corrected figure appears here:

Annals of Surgery. 269(4):e57, April 2019.

doi: 10.1097/SLA.0000000000002659

Objectives: We hypothesized that distinct sets of functional trajectories can be identified in the year before and after major surgery, with unique transition probabilities from pre to postsurgical functional trajectories, and that outcomes would be better among participants undergoing elective versus nonelective surgery.

Background: Major surgery is common and can be highly morbid in older persons. The relationship between the course of disability (ie, functional trajectory) before and after surgery in older adults has not been well-studied for most operations.

Methods: Prospective cohort study of 754 community-living persons 70 years or older. The analytic sample included 250 participants who underwent their first major surgery during the study period.

Results: Before surgery, 4 functional trajectories were identified: no disability (n = 60, 24.0%), and mild (n = 84, 33.6%), moderate (n = 73, 29.2%), and severe (n = 33, 13.2%) disability. After surgery, 4 functional trajectories were identified: rapid (n = 39, 15.6%), gradual (n = 76, 30.4%), partial (n = 70, 28.0%), and little (n = 57, 22.8%) improvement. Rapid improvement was seen for n = 31 (51.7%) participants with no disability before surgery, but was uncommon among those with mild disability (n = 8, 9.5%) and was not observed in the moderate and severe trajectory groups. For participants with mild to moderate disability before surgery, gradual improvement (n = 46, 54.8%) and partial improvement (n = 36, 49.3%) were most common. Most participants with severe disability (n = 27, 81.8%) before surgery exhibited little improvement. Outcomes were better for participants undergoing elective versus nonelective surgery.

Conclusions: Functional prognosis in the year after major surgery is highly dependent on premorbid function.

*Yale School of Medicine, Department of Internal Medicine, New Haven, CT

Yale School of Medicine, Department of Surgery, New Haven, CT.

Reprints: Thomas M. Gill, MD, Yale School of Medicine, Adler Geriatric Center, 20 York Street, New Haven, CT 06510. E-mail:

Author contributions: Dr Stabenau had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The specific contributions of all authors will be enumerated in the authorship, financial disclosure, and copyright transfer forms.

Funding: The work for this report was funded by a grant from the National Institute on Aging (R01AG17560). The study was conducted at the Yale Claude D. Pepper Older Americans Independence Center (P30AG21342).

Conflicts of interest: Dr Gill is the recipient of an Academic Leadership Award (K07AG043587) from the National Institute on Aging. The organizations funding this study had no role in the design or conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. The other authors report no conflicts of interest.

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