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Objectives To examine the effect of hospital readmission on functional recovery after elective surgery in older adults. Design Prospective cohort of individuals aged 70 and older undergoing elective surgery, enrolled from June 2010 to August 2013. Setting Two academic medical centers. Participants Community-dwelling older adults (N = 566; mean age ± standard deviation 77 ± 5) undergoing major elective surgery and expected to be admitted for at least 3 days. Measurements Readmission was assessed in multiple interviews with participants and family members over 18 months and validated against medical record review. Physical function was assessed according to ability to perform instrumental activities of daily living ( IADLs) and activities of daily living ( ADL), Medical Outcomes Study 12-item Short-Form Survey Physical Component Summary score, and a standardized functional composite. Results Two hundred fifty-five (45%) participants experienced 503 readmissions. Readmissions were associated with delays in functional recovery in all measures of physical function. Having two or more readmissions over 18 months was associated with persistent and significantly greater risk of IADL dependence (relative risk ( RR) = 1.8, 95% confidence interval ( CI) = 1.5-2.3) and ADL dependence ( RR = 3.3, 95% CI = 1.7-6.4). Degree of functional impairment increased progressively with number of readmissions. Readmissions within 2 months resulted in delayed functional recovery to baseline by 18 months, and readmissions between 12 and 18 months after surgery resulted in loss of functional recovery previously achieved. Conclusion Readmission after elective surgery may contribute to delays in functional recovery and persistent functional deficits in older adults. [ABSTRACT FROM AUTHOR]

Objectives To examine baseline (preoperative) neuropsychological test performance in a cohort of elderly individuals undergoing elective surgery and the association between specific neuropsychological domains and postoperative delirium. Design Ongoing prospective cohort study. Setting Successful Aging after Elective Surgery Study. Participants Elderly adults (N = 300) scheduled for elective (noncardiac) surgery. Measurements Neuropsychological testing, including standardized assessments of memory, divided and sustained attention, speed of mental processing, verbal fluency, working memory, language, and an overall measure of premorbid cognitive functioning, was performed 2 to 4 weeks before surgery. The relationship between the individual neuropsychological tests and delirium status was examined using linear regression, adjusting for age, sex, and education. Results Study participants were generally highly educated (mean years of education 15.0 ± 2.9), with minimal or no cognitive impairment (mean Modified Mini-Mental State Examination score 93.2 out of 100). After adjustment, participants who developed postoperative delirium had performed significantly lower preoperatively on measures of speed of mental processing and divided attention (Trail-Making Test Part B, mean difference 17.55, P = .02), category fluency (animal naming, mean difference −1.94, P = .01), sustained visual attention (Visual Search and Attention, mean difference −3.19, P < .001), and working memory with new learning and recall (Hopkins Verbal Learning Test-Revised Total mean difference −0.53 to −0.79, P < .01). Conclusion Individuals who later develop delirium have lower scores on tests evaluating the areas of complex attention, executive functioning, and rapid access to verbal knowledge or semantic networks at baseline. Future studies to better understand how the cognitive profiles identified may predispose individuals to developing delirium may help pave the way to greater understanding of the mechanisms of delirium. [ABSTRACT FROM AUTHOR]