A clinical study of decline in ADL level after surgeries for head and neck cancer

Abstract

In some cases, activities of daily living （ADL） decline after surgery for head and neck malignancy, and the patients are unable to leave the hospital and must be transferred to another hospital. The purpose of this study was to clarify the risk factors. We retrospectively analyzed 71 patients with head and neck cancer who were over 70 years old and who underwent curative surgery as an initial treatment from January 2006 to December 2015. We evaluated the ADL of each patient using Barthel’s index at the time of admission and discharge, and judged that ADL had declined in a case with a score of 60 or less at the time of discharge, and in a case with a score of 60 or less at the time of admission, more nursing care would be needed than at the time of admission as ADL declined. Adult Comorbidity Evaluation-27 index （ACE-27 index） was used for evaluating comorbidities. We examined preoperative conditions, surgical details, and postoperative courses. As a result, it was considered that the performance status （PS）, ASA physical status （ASA-PS）, cerebral nervous system comorbidities, moderate or more cardiovascular comorbidities, hypoalbuminemia, decreased respiratory function, and the occurrence of postoperative complications were risk factors for ADL decline. It is considered that patients aged 70 years or older with moderate comorbidities and poor respiratory function or nutritional status before surgery need careful monitoring for postoperative ADL decline regardless of surgical details.