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Linda M. Castell - One of the best experts on this subject based on the ideXlab platform.
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Biochemical markers for post-operative fatigue after Major Surgery.
Brain research bulletin, 2003Co-Authors: James Mcguire, Gary L. Ross, Huw Price, Neil Mortensen, Judy Evans, Linda M. CastellAbstract:To establish a link between tryptophan (a precursor for 5-hydroxytryptamine (5-HT) or serotonin, involved in sleep and fatigue) and post-operative fatigue after Major Surgery. There is a link between tryptophan (the precursor for the neurotransmitter 5-hydroxytryptamine), and its competitive binding with non-esterified fatty acids (NEFA) to albumin in the blood. An increase in the plasma concentration of free tryptophan can lead to an increased rate of synthesis of 5-HT in the brain. Free tryptophan competes with the branched chain amino acids (BCAA) for the same port of entry across the blood-brain barrier. It is suggested that the plasma concentration of these amino acids could be a marker of post-operative fatigue. In a previous study undertaken in this laboratory on patients undergoing two different types of Major Surgery, similar post-operative increases were observed in the plasma concentration of free tryptophan and the plasma concentration ratio of free tryptophan to branched chain amino acids. However, the study was retrospective and no measure of fatigue had been made. In the present study, this deficiency has been addressed by administering a modified Profile of Mood States questionnaire to patients undergoing reconstructive or colorectal Surgery. In addition, blood samples were measured for plasma free tryptophan, albumin, NEFA and branched chain amino acids before and on 2 days after Surgery. There was a significant correlation between fatigue scores and plasma free tryptophan (P<0.000), and the plasma concentration ratio of free tryptophan/BCAA (P<0.016) after Surgery in all the patients studied (n=34). This correlation was more marked in the colorectal-Surgery patients, in whom Surgery was more severe. In the three categories of patients receiving elective reconstructive Surgery (n=24), those having breast reductions (n=6) had a lower plasma concentration of NEFA and appeared to recover from fatigue more quickly than those with pre-tibial lacerations or malignant melanoma. These data provide further evidence of a possible biochemical mechanism for central fatigue which involves a precursor of 5-HT. The provision of branched chain amino acids may help to combat the surge in free tryptophan that occurs during stress such as Major Surgery.
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Biochemical markers for post-operative fatigue after Major Surgery.
Brain Research Bulletin, 2003Co-Authors: James Mcguire, Gary L. Ross, Huw Price, Neil Mortensen, Judy Evans, Linda M. CastellAbstract:Abstract Objective: To establish a link between tryptophan (a precursor for 5-hydroxytryptamine (5-HT) or serotonin, involved in sleep and fatigue) and post-operative fatigue after Major Surgery. Background: There is a link between tryptophan (the precursor for the neurotransmitter 5-hydroxytryptamine), and its competitive binding with non-esterified fatty acids (NEFA) to albumin in the blood. An increase in the plasma concentration of free tryptophan can lead to an increased rate of synthesis of 5-HT in the brain. Free tryptophan competes with the branched chain amino acids (BCAA) for the same port of entry across the blood–brain barrier. It is suggested that the plasma concentration of these amino acids could be a marker of post-operative fatigue. In a previous study undertaken in this laboratory on patients undergoing two different types of Major Surgery, similar post-operative increases were observed in the plasma concentration of free tryptophan and the plasma concentration ratio of free tryptophan to branched chain amino acids. However, the study was retrospective and no measure of fatigue had been made. Methods: In the present study, this deficiency has been addressed by administering a modified Profile of Mood States questionnaire to patients undergoing reconstructive or colorectal Surgery. In addition, blood samples were measured for plasma free tryptophan, albumin, NEFA and branched chain amino acids before and on 2 days after Surgery. Results: There was a significant correlation between fatigue scores and plasma free tryptophan (P Conclusions: These data provide further evidence of a possible biochemical mechanism for central fatigue which involves a precursor of 5-HT. The provision of branched chain amino acids may help to combat the surge in free tryptophan that occurs during stress such as Major Surgery.
Paul S. Myles - One of the best experts on this subject based on the ideXlab platform.
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Perioperative Fluid Therapy for Major Surgery.
Anesthesiology, 2019Co-Authors: Timothy E. Miller, Paul S. MylesAbstract:A moderately liberal IV fluid regimen, using a balanced crystalloid, and consideration of the use of an advanced hemodynamic monitor in a setting of an enhanced recovery pathway are recommended for Major Surgery. Supplemental Digital Content is available in the text.
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avoidance of nitrous oxide for patients undergoing Major Surgery a randomized controlled trial
Anesthesiology, 2007Co-Authors: Paul S. Myles, Kate Leslie, Matthew T. V. Chan, Andrew Forbes, Michael J. Paech, Philip J Peyton, Brendan S. Silbert, Elaine M. PascoeAbstract:BACKGROUND: Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear. METHODS: Patients having Major Surgery expected to last at least 2 h were randomly assigned to nitrous oxide-free (80% oxygen, 20% nitrogen) or nitrous oxide-based (70% N2O, 30% oxygen) anesthesia. Patients and observers were blind to group identity. The primary endpoint was duration of hospital stay. Secondary endpoints included duration of intensive care stay and postoperative complications; the latter included severe nausea and vomiting, and the following Major complications: pneumonia, pneumothorax, pulmonary embolism, wound infection, myocardial infarction, venous thromboembolism, stroke, awareness, and death within 30 days of Surgery. RESULTS: Of 3,187 eligible patients, 2,050 consenting patients were recruited. Patients in the nitrous oxide-free group had significantly lower rates of Major complications (odds ratio, 0.71; 95% confidence interval, 0.56-0.89; P = 0.003) and severe nausea and vomiting (odds ratio, 0.40; 95% confidence interval, 0.31-0.51; P < 0.001), but median duration of hospital stay did not differ substantially between groups (7.0 vs. 7.1 days; P = 0.06). Among patients admitted to the intensive care unit postoperatively, those in the nitrous oxide-free group were more likely to be discharged from the unit on any given day than those in the nitrous oxide group (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73; P = 0.02). CONCLUSIONS: Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after Major Surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing Major Surgery should be questioned.
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Avoidance of Nitrous Oxide for Patients Undergoing Major Surgery
Anesthesiology, 2007Co-Authors: Paul S. Myles, Kate Leslie, Matthew T. V. Chan, Andrew Forbes, Michael J. Paech, Philip J Peyton, Brendan S. Silbert, Elaine M. PascoeAbstract:Background Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear. Methods Patients having Major Surgery expected to last at least 2 h were randomly assigned to nitrous oxide-free (80% oxygen, 20% nitrogen) or nitrous oxide-based (70% N2O, 30% oxygen) anesthesia. Patients and observers were blind to group identity. The primary endpoint was duration of hospital stay. Secondary endpoints included duration of intensive care stay and postoperative complications; the latter included severe nausea and vomiting, and the following Major complications: pneumonia, pneumothorax, pulmonary embolism, wound infection, myocardial infarction, venous thromboembolism, stroke, awareness, and death within 30 days of Surgery. Results Of 3,187 eligible patients, 2,050 consenting patients were recruited. Patients in the nitrous oxide-free group had significantly lower rates of Major complications (odds ratio, 0.71; 95% confidence interval, 0.56-0.89; P = 0.003) and severe nausea and vomiting (odds ratio, 0.40; 95% confidence interval, 0.31-0.51; P < 0.001), but median duration of hospital stay did not differ substantially between groups (7.0 vs. 7.1 days; P = 0.06). Among patients admitted to the intensive care unit postoperatively, those in the nitrous oxide-free group were more likely to be discharged from the unit on any given day than those in the nitrous oxide group (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73; P = 0.02). Conclusions Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after Major Surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing Major Surgery should be questioned.
Elaine M. Pascoe - One of the best experts on this subject based on the ideXlab platform.
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avoidance of nitrous oxide for patients undergoing Major Surgery a randomized controlled trial
Anesthesiology, 2007Co-Authors: Paul S. Myles, Kate Leslie, Matthew T. V. Chan, Andrew Forbes, Michael J. Paech, Philip J Peyton, Brendan S. Silbert, Elaine M. PascoeAbstract:BACKGROUND: Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear. METHODS: Patients having Major Surgery expected to last at least 2 h were randomly assigned to nitrous oxide-free (80% oxygen, 20% nitrogen) or nitrous oxide-based (70% N2O, 30% oxygen) anesthesia. Patients and observers were blind to group identity. The primary endpoint was duration of hospital stay. Secondary endpoints included duration of intensive care stay and postoperative complications; the latter included severe nausea and vomiting, and the following Major complications: pneumonia, pneumothorax, pulmonary embolism, wound infection, myocardial infarction, venous thromboembolism, stroke, awareness, and death within 30 days of Surgery. RESULTS: Of 3,187 eligible patients, 2,050 consenting patients were recruited. Patients in the nitrous oxide-free group had significantly lower rates of Major complications (odds ratio, 0.71; 95% confidence interval, 0.56-0.89; P = 0.003) and severe nausea and vomiting (odds ratio, 0.40; 95% confidence interval, 0.31-0.51; P < 0.001), but median duration of hospital stay did not differ substantially between groups (7.0 vs. 7.1 days; P = 0.06). Among patients admitted to the intensive care unit postoperatively, those in the nitrous oxide-free group were more likely to be discharged from the unit on any given day than those in the nitrous oxide group (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73; P = 0.02). CONCLUSIONS: Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after Major Surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing Major Surgery should be questioned.
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Avoidance of Nitrous Oxide for Patients Undergoing Major Surgery
Anesthesiology, 2007Co-Authors: Paul S. Myles, Kate Leslie, Matthew T. V. Chan, Andrew Forbes, Michael J. Paech, Philip J Peyton, Brendan S. Silbert, Elaine M. PascoeAbstract:Background Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear. Methods Patients having Major Surgery expected to last at least 2 h were randomly assigned to nitrous oxide-free (80% oxygen, 20% nitrogen) or nitrous oxide-based (70% N2O, 30% oxygen) anesthesia. Patients and observers were blind to group identity. The primary endpoint was duration of hospital stay. Secondary endpoints included duration of intensive care stay and postoperative complications; the latter included severe nausea and vomiting, and the following Major complications: pneumonia, pneumothorax, pulmonary embolism, wound infection, myocardial infarction, venous thromboembolism, stroke, awareness, and death within 30 days of Surgery. Results Of 3,187 eligible patients, 2,050 consenting patients were recruited. Patients in the nitrous oxide-free group had significantly lower rates of Major complications (odds ratio, 0.71; 95% confidence interval, 0.56-0.89; P = 0.003) and severe nausea and vomiting (odds ratio, 0.40; 95% confidence interval, 0.31-0.51; P < 0.001), but median duration of hospital stay did not differ substantially between groups (7.0 vs. 7.1 days; P = 0.06). Among patients admitted to the intensive care unit postoperatively, those in the nitrous oxide-free group were more likely to be discharged from the unit on any given day than those in the nitrous oxide group (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73; P = 0.02). Conclusions Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after Major Surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing Major Surgery should be questioned.
James Mcguire - One of the best experts on this subject based on the ideXlab platform.
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Biochemical markers for post-operative fatigue after Major Surgery.
Brain research bulletin, 2003Co-Authors: James Mcguire, Gary L. Ross, Huw Price, Neil Mortensen, Judy Evans, Linda M. CastellAbstract:To establish a link between tryptophan (a precursor for 5-hydroxytryptamine (5-HT) or serotonin, involved in sleep and fatigue) and post-operative fatigue after Major Surgery. There is a link between tryptophan (the precursor for the neurotransmitter 5-hydroxytryptamine), and its competitive binding with non-esterified fatty acids (NEFA) to albumin in the blood. An increase in the plasma concentration of free tryptophan can lead to an increased rate of synthesis of 5-HT in the brain. Free tryptophan competes with the branched chain amino acids (BCAA) for the same port of entry across the blood-brain barrier. It is suggested that the plasma concentration of these amino acids could be a marker of post-operative fatigue. In a previous study undertaken in this laboratory on patients undergoing two different types of Major Surgery, similar post-operative increases were observed in the plasma concentration of free tryptophan and the plasma concentration ratio of free tryptophan to branched chain amino acids. However, the study was retrospective and no measure of fatigue had been made. In the present study, this deficiency has been addressed by administering a modified Profile of Mood States questionnaire to patients undergoing reconstructive or colorectal Surgery. In addition, blood samples were measured for plasma free tryptophan, albumin, NEFA and branched chain amino acids before and on 2 days after Surgery. There was a significant correlation between fatigue scores and plasma free tryptophan (P<0.000), and the plasma concentration ratio of free tryptophan/BCAA (P<0.016) after Surgery in all the patients studied (n=34). This correlation was more marked in the colorectal-Surgery patients, in whom Surgery was more severe. In the three categories of patients receiving elective reconstructive Surgery (n=24), those having breast reductions (n=6) had a lower plasma concentration of NEFA and appeared to recover from fatigue more quickly than those with pre-tibial lacerations or malignant melanoma. These data provide further evidence of a possible biochemical mechanism for central fatigue which involves a precursor of 5-HT. The provision of branched chain amino acids may help to combat the surge in free tryptophan that occurs during stress such as Major Surgery.
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Biochemical markers for post-operative fatigue after Major Surgery.
Brain Research Bulletin, 2003Co-Authors: James Mcguire, Gary L. Ross, Huw Price, Neil Mortensen, Judy Evans, Linda M. CastellAbstract:Abstract Objective: To establish a link between tryptophan (a precursor for 5-hydroxytryptamine (5-HT) or serotonin, involved in sleep and fatigue) and post-operative fatigue after Major Surgery. Background: There is a link between tryptophan (the precursor for the neurotransmitter 5-hydroxytryptamine), and its competitive binding with non-esterified fatty acids (NEFA) to albumin in the blood. An increase in the plasma concentration of free tryptophan can lead to an increased rate of synthesis of 5-HT in the brain. Free tryptophan competes with the branched chain amino acids (BCAA) for the same port of entry across the blood–brain barrier. It is suggested that the plasma concentration of these amino acids could be a marker of post-operative fatigue. In a previous study undertaken in this laboratory on patients undergoing two different types of Major Surgery, similar post-operative increases were observed in the plasma concentration of free tryptophan and the plasma concentration ratio of free tryptophan to branched chain amino acids. However, the study was retrospective and no measure of fatigue had been made. Methods: In the present study, this deficiency has been addressed by administering a modified Profile of Mood States questionnaire to patients undergoing reconstructive or colorectal Surgery. In addition, blood samples were measured for plasma free tryptophan, albumin, NEFA and branched chain amino acids before and on 2 days after Surgery. Results: There was a significant correlation between fatigue scores and plasma free tryptophan (P Conclusions: These data provide further evidence of a possible biochemical mechanism for central fatigue which involves a precursor of 5-HT. The provision of branched chain amino acids may help to combat the surge in free tryptophan that occurs during stress such as Major Surgery.
Thomas M. Gill - One of the best experts on this subject based on the ideXlab platform.
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The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States
2020Co-Authors: Robert D. Becher, Linda Leo-summers, Brent C. Vander Wyk, Mayur M. Desai, Thomas M. GillAbstract:ImportanceAs the population of the United States (US) ages, there is considerable interest in ensuring safe and high-quality surgical care for older persons. Yet, valid, generalizable data on the occurrence of Major Surgery in the geriatric population are sparse. ObjectiveTo estimate the incidence and cumulative risk of Major Surgery in older persons over a 5-year period and evaluate how these estimates differ according to demographic and geriatric characteristics. DesignProspective longitudinal study. SettingContinental US from 2011 to 2016. Participants5,571 community-living fee-for-service Medicare beneficiaries, aged 65+, from the National Health and Aging Trends Study (NHATS). Main Outcomes and MeasuresMajor surgeries were identified through linkages with data from the Centers for Medicare & Medicaid Services. Data on frailty and dementia were obtained from the baseline NHATS assessment. ResultsThe nationally-representative incidence of Major Surgery per 100 person-years was 8.8 (95% confidence interval [CI], 8.2-9.5), with estimates of 5.2 (95% CI, 4.7-5.7) and 3.7 (95% CI, 3.3-4.1) for elective and non-elective surgeries. The adjusted incidence of Major Surgery peaked at 10.8 (95% CI, 9.4-12.4) in persons 75-79 years, increased from 6.6 (95% CI, 5.8-7.5) in the non-frail group to 10.3 (95% CI, 8.9-11.9) in the frail group, and was similar by sex (males 8.6 [95% CI, 7.7-9.6]; females 8.3 [95% CI, 7.5-9.1]) and dementia (no 8.6 [95% CI, 7.9-9.3]; possible 7.8 [95% CI, 6.3-9.6]; probable 8.1 [95% CI, 6.7-9.9]). The 5-year cumulative risk of Major Surgery was 13.8% (95% CI, 12.2%-15.5%), representing nearly 5 million unique older persons (4,958,048 [95% CI, 4,345,342-5,570,755]), including 12.1% (95% CI, 9.5%-14.6%) in persons 85-89 years, 9.1% (95% CI, 7.2%-11.0%) in those [≥]90 years, 12.1% (95% CI, 9.9%-14.4%) in those with frailty, and 12.4% (95% CI, 9.8%-15.0%) in those with probable dementia. Conclusions and RelevanceMajor Surgery is a common event in the lives of community-living older persons, including high-risk vulnerable subgroups such as the oldest old, those with frailty or dementia, and those undergoing non-elective Surgery. The burden of Major Surgery in older Americans will add to the challenges ahead for the US health care system in our aging society. KEY POINTSO_ST_ABSQuestionC_ST_ABSWhat is the incidence and cumulative risk of Major Surgery in older persons in the United States? FindingsIn this prospective longitudinal study, data from 5,571 community-living fee-for-service Medicare beneficiaries were used to calculate nationally-representative estimates for the incidence and cumulative risk of Major Surgery over a 5-year period. Nearly 9 Major surgeries were performed annually for every 100 older persons, and more than 1 in 7 Medicare beneficiaries underwent a Major Surgery over 5 years, representing nearly 5 million unique older persons. MeaningMajor Surgery is a common event in the lives of community-living older persons.
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Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons.
Annals of surgery, 2020Co-Authors: Thomas M. Gill, Evelyne A. Gahbauer, Linda Leo-summers, Terrence E. Murphy, Ling Han, Robert D. BecherAbstract:Objective To evaluate the functional effects of intervening illnesses and injuries, that is, events, in the year after Major Surgery. Background Intervening events have pronounced deleterious effects on functional status in older persons, but have not been carefully evaluated after Major Surgery. Methods From a cohort of 754 community-living persons, aged 70+ years, 317 admissions for Major Surgery were identified from 244 participants who were discharged from the hospital. Functional status (13 activities) and exposure to intervening hospitalizations, emergency department (ED) visits, and restricted activity were assessed each month. Comprehensive assessments (for covariates) were completed every 18 months. Results In the year after Major Surgery, exposure rates (95% CI) per 100-person months to hospitalizations, ED visits, and restricted activity were 10.0 (8.0-12.5), 3.9 (2.8-5.4), and 12.3 (10.2-14.8) for functional recovery and 7.2 (6.1-8.5), 2.5 (1.9-3.2), 11.2 (9.8-12.9) for functional decline. Each of the 3 intervening events were independently associated with reduced recovery, with adjusted hazard ratios (95% CI) of 0.20 (0.09-0.47), 0.35 (0.15-0.81), and 0.57 (0.36-0.90) for hospitalizations, ED visits, and restricted activity. For functional decline, the corresponding odds ratios (95% CI) were 5.68 (3.87-8.33), 1.90 (1.13-3.20), and 1.30 (0.96-1.75). The effect sizes for hospitalizations and ED visits were larger than those for the covariates. Conclusions Intervening illnesses/injuries are common in the year after Major Surgery, and those leading to hospitalization and ED visit are strongly associated with adverse functional outcomes, with effect sizes larger than those of traditional risk factors.
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Factors Associated With Functional Recovery Among Older Survivors of Major Surgery.
Annals of surgery, 2019Co-Authors: Robert D. Becher, Hans F. Stabenau, Evelyne A. Gahbauer, Linda Leo-summers, Terrence E. Murphy, Thomas M. GillAbstract:OBJECTIVE The objectives of the current study were 2-fold: first, to evaluate the incidence and time to recovery of premorbid function within 6 months of Major Surgery and second, to identify factors associated with functional recovery among older persons who survive a Major Surgery with increased disability. BACKGROUND Most older persons would not choose a surgical treatment resulting in persistently increased postsurgical disability, even if survival was assured. Potential predictors of functional recovery after Major Surgery have, however, not been well-studied among geriatric patients. METHODS It is a prospective longitudinal study of 754 community-living persons 70 years or older. The analytic sample included 266 person-admissions in which participants survived Major Surgery with increased disability and were monitored on a monthly basis for 6 months. RESULTS Of the 266 person-admissions assessed, 174 (65.4%) recovered to their presurgical level of function, with median time to recovery of 2 months (interquartile range, 1-3), whereas 16 (6.0%) died. Two factors were significantly associated with an increased likelihood of functional recovery: being nonfrail (hazard ratio 1.60; 95% confidence interval 1.03-2.51; P = 0.038) and having elective Surgery (hazard ratio 1.72; 95% confidence interval 1.14-2.59; P = 0.009). Three factors were associated with a reduced likelihood of functional recovery: hearing impairment, greater increase in postsurgical disability in the month after hospital discharge, and years of education. CONCLUSIONS Among older persons, nonfrailty and elective Surgery were positively associated with functional recovery, whereas hearing impairment, greater increases in postsurgical disability, and years of education were associated with higher risk of protracted disability.
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Functional Trajectories Before and After Major Surgery in Older Adults.
Annals of surgery, 2018Co-Authors: Hans F. Stabenau, Robert D. Becher, Evelyne A. Gahbauer, Linda Leo-summers, Heather G. Allore, Thomas M. GillAbstract:OBJECTIVES We hypothesized that distinct sets of functional trajectories can be identified in the year before and after Major Surgery, with unique transition probabilities from pre to postsurgical functional trajectories, and that outcomes would be better among participants undergoing elective versus nonelective Surgery. BACKGROUND Major Surgery is common and can be highly morbid in older persons. The relationship between the course of disability (ie, functional trajectory) before and after Surgery in older adults has not been well-studied for most operations. METHODS Prospective cohort study of 754 community-living persons 70 years or older. The analytic sample included 250 participants who underwent their first Major Surgery during the study period. RESULTS Before Surgery, 4 functional trajectories were identified: no disability (n = 60, 24.0%), and mild (n = 84, 33.6%), moderate (n = 73, 29.2%), and severe (n = 33, 13.2%) disability. After Surgery, 4 functional trajectories were identified: rapid (n = 39, 15.6%), gradual (n = 76, 30.4%), partial (n = 70, 28.0%), and little (n = 57, 22.8%) improvement. Rapid improvement was seen for n = 31 (51.7%) participants with no disability before Surgery, but was uncommon among those with mild disability (n = 8, 9.5%) and was not observed in the moderate and severe trajectory groups. For participants with mild to moderate disability before Surgery, gradual improvement (n = 46, 54.8%) and partial improvement (n = 36, 49.3%) were most common. Most participants with severe disability (n = 27, 81.8%) before Surgery exhibited little improvement. Outcomes were better for participants undergoing elective versus nonelective Surgery. CONCLUSIONS Functional prognosis in the year after Major Surgery is highly dependent on premorbid function.
