Impaired recovery of strength in older patients after major abdominal surgery

J. M. Watters, S. M. Clancey, S. B. Moulton, K. M. Briere, J. M. Zhu, J. L. Meakins, P. R. Schloerb, Donald Trunkey, J. D. Hardy, C. R. Hanlon, S. M. Levenson, B. Eiseman, F. D. Moore

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Objective: This study compared changes in muscle strength after major elective 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 negative nitrogen balance are characteristic metabolic responses to surgical illness. With a substantial loss of muscle mass typical of advancing age, the authors postulated that older patients would be weaker during acute surgical illness and less able to maintain muscle function and meet metabolic demands. Methods: Active, community-dwelling individuals undergoing major abdominal procedures who were 70 years of age or older or 50 years of age or younger were studied. Total body water (TBW) was determined preoperatively by deuterium oxide dilution. Maximal voluntary handgrip, respiratory muscle strength, and visual analog pain scores were measured preoperatively and on postoperative days 2, 4, and 6. All urine was collected postoperatively for 7 days for determination of total nitrogen, creatinine, and cortisol. Results: The young (age, 36 ± 9 years [mean ± standard deviation]; n = 20) and old groups (age, 77 ± 5 years; n = 20) were similar regarding weight, sex distribution, nutritional status, surgical procedures and anesthesia, and 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 preoperative 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 lower absolute levels in the older patients. The rate of recovery of strength was substantially less rapid and complete in older patients. Older patients had less postoperative pain and received much less parenteral narcotic than younger patients. Postoperative urine nitrogen was similar in each group. Recovery of strength was not related to malignancy, preoperative strength, muscle mass (urine creatinine), lean body mass (TBW), sex, malignancy, pain, or narcotic administration. Conclusions: Older patients are weaker preoperatively than younger patients; their strength falls to lower levels after surgery and their postoperative recovery of strength is impaired. The lesser preoperative strength of older patients is due in large part but not totally to diminished muscle mass. Their impaired postoperative recovery appears to be related to more acute factors, such as muscle energetics or substrate availability.

Original languageEnglish (US)
Pages (from-to)380-393
Number of pages14
JournalAnnals of Surgery
Volume218
Issue number3
StatePublished - 1993
Externally publishedYes

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Urine
Muscle Strength
Nitrogen
Muscles
Creatinine
Age Groups
Body Water
Narcotics
Hydrocortisone
Deuterium Oxide
Independent Living
Pain
Sex Distribution
Respiratory Muscles
Muscle Proteins
Postoperative Care
Postoperative Pain
Body Composition
Nutritional Status
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Watters, J. M., Clancey, S. M., Moulton, S. B., Briere, K. M., Zhu, J. M., Meakins, J. L., ... Moore, F. D. (1993). Impaired recovery of strength in older patients after major abdominal surgery. Annals of Surgery, 218(3), 380-393.

Impaired recovery of strength in older patients after major abdominal surgery. / Watters, J. M.; Clancey, S. M.; Moulton, S. B.; Briere, K. M.; Zhu, J. M.; Meakins, J. L.; Schloerb, P. R.; Trunkey, Donald; Hardy, J. D.; Hanlon, C. R.; Levenson, S. M.; Eiseman, B.; Moore, F. D.

In: Annals of Surgery, Vol. 218, No. 3, 1993, p. 380-393.

Research output: Contribution to journalArticle

Watters, JM, Clancey, SM, Moulton, SB, Briere, KM, Zhu, JM, Meakins, JL, Schloerb, PR, Trunkey, D, Hardy, JD, Hanlon, CR, Levenson, SM, Eiseman, B & Moore, FD 1993, 'Impaired recovery of strength in older patients after major abdominal surgery', Annals of Surgery, vol. 218, no. 3, pp. 380-393.
Watters JM, Clancey SM, Moulton SB, Briere KM, Zhu JM, Meakins JL et al. Impaired recovery of strength in older patients after major abdominal surgery. Annals of Surgery. 1993;218(3):380-393.
Watters, J. M. ; Clancey, S. M. ; Moulton, S. B. ; Briere, K. M. ; Zhu, J. M. ; Meakins, J. L. ; Schloerb, P. R. ; Trunkey, Donald ; Hardy, J. D. ; Hanlon, C. R. ; Levenson, S. M. ; Eiseman, B. ; Moore, F. D. / Impaired recovery of strength in older patients after major abdominal surgery. In: Annals of Surgery. 1993 ; Vol. 218, No. 3. pp. 380-393.
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abstract = "Objective: This study compared changes in muscle strength after major elective 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 negative nitrogen balance are characteristic metabolic responses to surgical illness. With a substantial loss of muscle mass typical of advancing age, the authors postulated that older patients would be weaker during acute surgical illness and less able to maintain muscle function and meet metabolic demands. Methods: Active, community-dwelling individuals undergoing major abdominal procedures who were 70 years of age or older or 50 years of age or younger were studied. Total body water (TBW) was determined preoperatively by deuterium oxide dilution. Maximal voluntary handgrip, respiratory muscle strength, and visual analog pain scores were measured preoperatively and on postoperative days 2, 4, and 6. All urine was collected postoperatively for 7 days for determination of total nitrogen, creatinine, and cortisol. Results: The young (age, 36 ± 9 years [mean ± standard deviation]; n = 20) and old groups (age, 77 ± 5 years; n = 20) were similar regarding weight, sex distribution, nutritional status, surgical procedures and anesthesia, and 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 preoperative 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 lower absolute levels in the older patients. The rate of recovery of strength was substantially less rapid and complete in older patients. Older patients had less postoperative pain and received much less parenteral narcotic than younger patients. Postoperative urine nitrogen was similar in each group. Recovery of strength was not related to malignancy, preoperative strength, muscle mass (urine creatinine), lean body mass (TBW), sex, malignancy, pain, or narcotic administration. Conclusions: Older patients are weaker preoperatively than younger patients; their strength falls to lower levels after surgery and their postoperative recovery of strength is impaired. The lesser preoperative strength of older patients is due in large part but not totally to diminished muscle mass. Their impaired postoperative recovery appears to be related to more acute factors, such as muscle energetics or substrate availability.",
author = "Watters, {J. M.} and Clancey, {S. M.} and Moulton, {S. B.} and Briere, {K. M.} and Zhu, {J. M.} and Meakins, {J. L.} and Schloerb, {P. R.} and Donald Trunkey and Hardy, {J. D.} and Hanlon, {C. R.} and Levenson, {S. M.} and B. Eiseman and Moore, {F. D.}",
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T1 - Impaired recovery of strength in older patients after major abdominal surgery

AU - Watters, J. M.

AU - Clancey, S. M.

AU - Moulton, S. B.

AU - Briere, K. M.

AU - Zhu, J. M.

AU - Meakins, J. L.

AU - Schloerb, P. R.

AU - Trunkey, Donald

AU - Hardy, J. D.

AU - Hanlon, C. R.

AU - Levenson, S. M.

AU - Eiseman, B.

AU - Moore, F. D.

PY - 1993

Y1 - 1993

N2 - Objective: This study compared changes in muscle strength after major elective 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 negative nitrogen balance are characteristic metabolic responses to surgical illness. With a substantial loss of muscle mass typical of advancing age, the authors postulated that older patients would be weaker during acute surgical illness and less able to maintain muscle function and meet metabolic demands. Methods: Active, community-dwelling individuals undergoing major abdominal procedures who were 70 years of age or older or 50 years of age or younger were studied. Total body water (TBW) was determined preoperatively by deuterium oxide dilution. Maximal voluntary handgrip, respiratory muscle strength, and visual analog pain scores were measured preoperatively and on postoperative days 2, 4, and 6. All urine was collected postoperatively for 7 days for determination of total nitrogen, creatinine, and cortisol. Results: The young (age, 36 ± 9 years [mean ± standard deviation]; n = 20) and old groups (age, 77 ± 5 years; n = 20) were similar regarding weight, sex distribution, nutritional status, surgical procedures and anesthesia, and 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 preoperative 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 lower absolute levels in the older patients. The rate of recovery of strength was substantially less rapid and complete in older patients. Older patients had less postoperative pain and received much less parenteral narcotic than younger patients. Postoperative urine nitrogen was similar in each group. Recovery of strength was not related to malignancy, preoperative strength, muscle mass (urine creatinine), lean body mass (TBW), sex, malignancy, pain, or narcotic administration. Conclusions: Older patients are weaker preoperatively than younger patients; their strength falls to lower levels after surgery and their postoperative recovery of strength is impaired. The lesser preoperative strength of older patients is due in large part but not totally to diminished muscle mass. Their impaired postoperative recovery appears to be related to more acute factors, such as muscle energetics or substrate availability.

AB - Objective: This study compared changes in muscle strength after major elective 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 negative nitrogen balance are characteristic metabolic responses to surgical illness. With a substantial loss of muscle mass typical of advancing age, the authors postulated that older patients would be weaker during acute surgical illness and less able to maintain muscle function and meet metabolic demands. Methods: Active, community-dwelling individuals undergoing major abdominal procedures who were 70 years of age or older or 50 years of age or younger were studied. Total body water (TBW) was determined preoperatively by deuterium oxide dilution. Maximal voluntary handgrip, respiratory muscle strength, and visual analog pain scores were measured preoperatively and on postoperative days 2, 4, and 6. All urine was collected postoperatively for 7 days for determination of total nitrogen, creatinine, and cortisol. Results: The young (age, 36 ± 9 years [mean ± standard deviation]; n = 20) and old groups (age, 77 ± 5 years; n = 20) were similar regarding weight, sex distribution, nutritional status, surgical procedures and anesthesia, and 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 preoperative 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 lower absolute levels in the older patients. The rate of recovery of strength was substantially less rapid and complete in older patients. Older patients had less postoperative pain and received much less parenteral narcotic than younger patients. Postoperative urine nitrogen was similar in each group. Recovery of strength was not related to malignancy, preoperative strength, muscle mass (urine creatinine), lean body mass (TBW), sex, malignancy, pain, or narcotic administration. Conclusions: Older patients are weaker preoperatively than younger patients; their strength falls to lower levels after surgery and their postoperative recovery of strength is impaired. The lesser preoperative strength of older patients is due in large part but not totally to diminished muscle mass. Their impaired postoperative recovery appears to be related to more acute factors, such as muscle energetics or substrate availability.

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