# The Incidence of Poor Postoperative Recovery Characterized Using ‘Days Alive and Out of Hospital’ in Octogenarians and Nonagenarians—A Retrospective Cohort Study

## TL;DR

This study finds that 17% of patients aged 80+ have poor recovery after surgery, using a new metric called 'days alive and out of hospital'.

## Contribution

The study introduces DAOH90 as a patient-centered metric to assess postoperative recovery in elderly patients.

## Key findings

- 17% of patients aged 80+ had poor postoperative recovery, defined as DAOH90 ≤ 45 days.
- ASA physical status, renal failure, and high-risk surgery were significant risk factors for poor recovery.
- 38% of patients with poor recovery survived but spent over 45 days in the hospital.

## Abstract

Background: Studies assessing poor postoperative recovery using patient-centered metrics among older adults are scarce. We aimed to explore poor postoperative recovery in octogenarians and nonagenarians, characterized using the validated patient-centered tool ‘days alive and out of hospital’ (DAOH). Methods: This retrospective cohort study included patients aged ≥ 80 years who had non-palliative surgery at a tertiary academic center between January 2017 and July 2021. We explored the incidence of DAOH at 90 days (DAOH90) ≤ 45 days as a pragmatic patient-centered marker of poor postoperative recovery. We also identified independent risk factors associated with this outcome using logistic regression models. Sensitivity analyses were performed using similar regression models. Results: Among 3683 included patients (median age 84 years), 640 patients (17%) had poor postoperative recovery. Of them, 240 patients (38%) survived the 90-day postoperative period but suffered a cumulative hospitalization period of over 45 days, and 400 patients (62%) died during the 90-day postoperative period. The most significant risk factors were ASA physical status classification (adjusted odds ratio (aOR) 3.52 [95% CI 2.55–4.87] for class 3E-5E compared to class 1–2), renal failure (aOR 3.49 [2.01–6.06] for GFR < 15 compared to GFR > 60 mL/min/1.73 m2), and high-risk surgery (aOR 1.85 [1.47–2.32]). Conclusions: We found a non-trivial rate of poor postoperative recovery in octogenarians and nonagenarians. DAOH90 ≤ 45 days is a simple, clear, and intuitive tool that may enhance patient-centered research and promote communication about expected outcomes, support shared decision making, and provide personalized risk assessment aligned with older patients’ goals of care.