IMPAIRED RECOVERY OF STRENGTH IN OLDER PATIENTS AFTER MAJOR ABDOMINAL-SURGERY

Objective This study compared changes in muscle strength after major e lective abdominal surgery in young and old patients, and related these changes to body composition and nitrogen balance. Summary Background Data The breakdown of muscle protein, erosion of lean tissue, and nega tive nitrogen balance are characteristic metabolic responses to surgic al illness. With a substantial loss of muscle mass typical of advancin g age, the authors postulated that older patients would be weaker duri ng acute surgical illness and less able to maintain muscle function an d meet metabolic demands. Methods Active, community-dwelling individua ls undergoing major abdominal procedures who were 70 years of age or o lder or 50 years of age or younger were studied. Total body water (TBW ) was determined preoperatively by deuterium oxide dilution. Maximal v oluntary handgrip, respiratory muscle strength, and visual analog pain scores were measured preoperatively and on postoperative days 2, 4, a nd 6. All urine was collected postoperatively for 7 days for determina tion of total nitrogen, creatinine, and cortisol. Results The young (a ge, 36 +/- 9 years [mean +/- standard deviation]; n = 20) and old grou ps (age, 77 +/- 5 years; n = 20) were similar regarding weight, sex di stribution, nutritional status, surgical procedures and anesthesia, an d postoperative urine cortisol values. Age group, time after operation , and interaction effects were significant for each strength variable (all p < 0.005 by analysis of variance). Older patients had lower preo perative strength (29% to 41%) and mean 24-hour urine creatinine (27%) . Postoperative strength was decreased most markedly on postoperative day 2, with similar proportional changes in the two age groups but low er absolute levels in the older patients. The rate of recovery of stre ngth was substantially less rapid and complete in older patients. Olde r patients had less postoperative pain and received much less parenter al narcotic than younger patients. Postoperative urine nitrogen was si milar in each group. Recovery of strength was not related to malignanc y, preoperative strength, muscle mass (urine creatinine), lean body ma ss (TBW), sex, malignancy, pain, or narcotic administration. Conclusio ns Older patients are weaker preoperatively than younger patients; the ir strength falls to lower levels after surgery and their postoperativ e recovery of strength is impaired. The lesser preoperative