Preoperative risk assessment for loss of independence after hepatopancreaticobiliary surgery in the elderly: a prospective multicenter study.

Background: Maintaining an independent life after hepatopancreaticobiliary surgery is a major goal of elderly people. This prospective study aimed to identify the risk factors for postoperative loss of independence after hepatopancreaticobiliary surgery in elderly individuals.

Methods: Between February and December 2023, independently living elderly individuals ≥65 years old who were scheduled for hepatopancreaticobiliary surgery and approved for preoperative evaluation of frailty at five institutions were registered. Frailty was evaluated according to the "Kihon Checklist, a phenotypic frailty index." Postoperative loss of independence was defined as hospitalization, need for nursing care, and/or transfer to a rehabilitation facility at 90 days and/or mortality within 90 days.

Results: Of the registered 201 patients, 58 (28.9%) patients were classified as frail, and 21 (10.4%) developed postoperative loss of independence. Univariate and multivariate analyses indicated that frailty (P = 0.03), cerebrovascular and/or neurological diseases (P = 0.04), and open surgery (P = 0.02) were independent risk factors for postoperative loss of independence after hepatopancreaticobiliary surgery. Among the patients with postoperative loss of independence, 2.8% had no applicable risk factors, and 31.4% had ≥2 of these factors (P < 0.001). The incidence of postoperative loss of independence tended to be higher in frail patients than in nonfrail patients [minimally invasive surgery: 9.4% vs. open surgery: 30.8%, P = 0.050].

Conclusions: Postoperative loss of independence was predictable in elderly patients identified as frail by the Kihon Checklist after hepatopancreaticobiliary surgery. Minimally invasive surgery for frail elderly individuals may reduce the risk of postoperative loss of independence.