# Association between reduced physical performance measures and short-term consequences after major emergency abdominal surgery: a prospective cohort study

## TL;DR

This study finds that lower physical performance scores after major emergency abdominal surgery are linked to more severe complications.

## Contribution

The study demonstrates the feasibility and predictive value of physical performance tests in postoperative emergency abdominal surgery patients.

## Key findings

- Low DEMMI scores and hand grip strength are independent risk factors for severe postoperative complications.
- Only 21% of patients could complete the 30-s chair-stand test postoperatively.
- 68% of patients could undergo physiotherapeutic evaluation with DEMMI and hand grip strength tests.

## Abstract

Major emergency abdominal surgery is associated with high morbidity with outcomes worse than for similar elective surgery, including complicated physical recovery, increased need for rehabilitation, and prolonged hospitalisation.

To investigate whether low physical performance test scores were associated with an increased risk of postoperative complications, and, furthermore, to investigate the feasibility of postoperative performance tests in patients undergoing major emergency abdominal surgery. We hypothesize that patients with low performance test scores suffer more postoperative complications.

The study is a prospective observational cohort study including all patients who underwent major abdominal surgery at the Department of Surgery at Zealand University Hospital between 1st March 2017 and 31st January 2019. Patients were evaluated with De Morton Mobility Index (DEMMI) score, hand grip strength, and 30-s chair-stand test.

The study included 488 patients (median age 69, 50.6% male). Physiotherapeutic evaluation including physical performance tests with DEMMI and hand grip strength in the immediate postoperative period were feasible in up to 68% of patients undergoing major emergency abdominal surgery. The 30-s chair-stand test was less viable in this population; only 21% of the patients could complete the 30-s chair-stand test during the postoperative period. In logistic regression models low DEMMI score (< 40) and ASA classification and low hand grip strength (< 20 kg for women, < 30 kg for men were independent risk factors for the development of postoperative severe complications Clavien–Dindo (CD) grade ≥ 3.

In patients undergoing major emergency surgery low performance test scores (DEMMI and hand grip strength), were independently associated with the development of significant postoperative complications CD ≥ 3.

The online version contains supplementary material available at 10.1007/s00068-023-02408-4.