Activities of daily living after surgery among older patients with gastrointestinal and hepatobiliary-pancreatic cancers - a retrospective observational study using nationwide health services utilisation data from Japan

Q: What was the study’s main objective regarding ADLs after surgery?

To evaluate activities of daily living after oncological surgery in patients with gastrointestinal and hepatobiliary-pancreatic cancers, stratified by age group, using Japan nationwide data.

Q: How were outcomes measured after surgery?

Outcomes included the proportion of ADL decline at discharge, death, and unexpected readmission within 6 weeks postsurgery, calculated by age group.

Sep 24, 2026

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Activities of daily living (ADLs) after oncological surgery were evaluated for inpatients with gastrointestinal and hepatobiliary-pancreatic cancers by age group in Japan. A retrospective observational study used nationwide health services utilisation data from 1 Jan 2015 to 31 Dec 2016 across 431 hospitals. Patients receiving ESD/EMR or laparoscopic/open surgery were followed for ADL decline at discharge, death, and unexpected readmission within 6 weeks, with outcomes stratified by age (40–74, 75–79, ≥80).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Objectives

Design

Setting

Participants

Outcome measures

Results

Conclusions

Strengths and limitations of this study

Introduction

Open access Original research Activities of daily living after surgery among older patients with gastrointestinal and hepatobiliarypancreatic cancers: a retrospective observational study using nationwide health services utilisation data from Japan Ayako Okuyama ,1,2 Hisashi Kosaka,3 Masaki Kaibori,3 Takahiro Higashi,2 Asao Ogawa4 To cite: Okuyama A, Kosaka H, Kaibori M, et al. Activities of daily living after surgery among older patients with gastrointestinal and hepatobiliary-pancreatic cancers: a retrospective observational study using nationwide health services utilisation data from Japan. BMJ Open 2023;13:e070415 . doi:10 . 1136/ bmjopen-2022-070415 ► Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online ([http://dx.doi.org/10.1136/](http://dx.doi.org/10.1136/)[ ](http://dx.doi.org/10.1136/)[bmjopen-2022-070415](bmjopen-2022-070415)) . Received 28 November 2022 Accepted 12 May 2023 © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. For numbered affiliations see end of article. Correspondence to DrAyako Okuyama; [okuyama.ayako.r3@slcn.ac.jp](okuyama.ayako.r3@slcn.ac.jp) ABSTRACT Objectives The effectiveness and impact of any treatment on patients’ physical functions, especially in older patients, should be closely considered. This study aimed to evaluate activities of daily living (ADLs) after oncological surgery inpatients with gastrointestinal and hepatobiliary-pancreatic cancers by age groups in Japan. Design Retrospective observational study using health services utilisation data from 1 January 2015 to 31 December 2016. Setting Data for patients with gastrointestinal and hepatobiliary-pancreatic cancers diagnosed in 2015 from 431 hospitals nationwide in Japan. Participants Patients who underwent endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR) and laparoscopic or open surgery were included. Outcome measures The proportion of ADL decline at discharge, death and unexpected readmission within 6 weeks postsurgery was calculated by age groups (40–74, 75–79 and ≥80 years) . Results Data for 68 032 patients were analysed. The difference in the proportion of ADL decline after ESD/EMR between patients aged ≥80 years and <75 years was marginal (0 .8%–2 .5%), whereas that after laparoscopic (4.8%–5.9%) or open surgery (4.6%–9.4%) was large, except for pancreatic cancer (3 .0%) . Among patients with gastric cancer who underwent laparoscopic or open surgery, the proportion of unexpected readmission tended to be higher in patients aged ≥80 years than in the remaining younger patients (laparoscopic surgery 4 .8% vs 2.3%(p=0 .001); open surgery 7 .3% vs 4 .4%(p<0 .001)) . The postoperative mortality rate was <3%(<10 cases) across all ages and cancer types. Conclusions In ESD/EMR, postoperative ADL decline was almost the same between older and younger patients. Laparoscopic or open surgery is associated with increased rates of ADL decline in older patients, especially in those aged ≥80 years. The potential decline in ADLs should be STRENGTHS AND LIMITATIONS OF THIS STUDY ⇒ This study used nationwide data that covered approximately 49% of new cancer cases in Japan. ⇒ Activities of daily living (ADL) after oncological surgery were examined by age groups. ⇒ Information on ADLs was only available at the time of hospital admission and discharge. ⇒ The extent to which doctors’ judgements and patients’ preferences influenced their treatment choice remains unclear. ⇒ The impact of in-hospital rehabilitation on ADLs has not been considered. carefully considered preoperatively to best maintain the patient’s quality of life postsurgery. INTRODUCTION Age is associated with a progressive decline in the functional reserve of multiple organ systems and an increased incidence o

FAQs

What was the study’s main objective regarding ADLs after surgery?

To evaluate activities of daily living after oncological surgery in patients with gastrointestinal and hepatobiliary-pancreatic cancers, stratified by age group, using Japan nationwide data.

Which treatments and patient groups were included in the analysis?

Patients who underwent endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and laparoscopic or open surgery were included, with outcomes compared across age groups (40–74, 75–79, and ≥80 years).

How were outcomes measured after surgery?

Outcomes included the proportion of ADL decline at discharge, death, and unexpected readmission within 6 weeks postsurgery, calculated by age group.

Sep 24, 2026

Uploaded by Aurelia