Baseline Physiological Reserve Provides Greater Explanatory Value Than Discharge-Attained Strength Change for Early Postoperative Outcomes After Elective Abdominal Surgery.

Authors

Sergii Girnyi, Virginia Boccardi, Elena Montanari, Eugenia Semeraro, Alessandra Marano, Mauro Santarelli, Ruslan Duka, Robert Molchanov, Silvia Malerba, Francesco Paolo Prete, Mario Testini, Francesco Pizza, Luigi Marano

Published in

Journal of investigative surgery : the official journal of the Academy of Surgical Research. Volume 39. Issue 1. Pages 2719065. Epub Aug 19, 2026.

Abstract

Acute perioperative handgrip strength change measured at discharge (Δacute) is often interpreted as a marker of vulnerability. However, it is discharge-anchored, influenced by peri-discharge conditions, and not measured at a standardized postoperative timepoint. We examined whether Δacute was independently associated with prolonged length of stay (LOS) after elective abdominal surgery once baseline physiological reserve was considered.
Adults undergoing elective abdominal surgery were prospectively enrolled in a multicenter observational cohort. Handgrip strength (HGS) was assessed at admission and discharge, and frailty using the Fried phenotype. Δacute was defined as discharge minus admission HGS. The primary outcome was LOS >10 days. Associations were examined using correlation and multivariable logistic regression, with sensitivity analyses addressing extreme values and non-normal distributions.
Among 223 patients (median age, 65 years), 48 (21.5%) had prolonged LOS. Frailty status (OR 2.63, 95% CI 1.47-4.70) and oncologic surgery were independently associated with prolonged LOS, whereas admission HGS was not significant after adjustment. Δacute showed substantial interindividual variability, correlated inversely with admission HGS (r = -0.325, p < 0.001), and differed by surgical context, but was not associated with prolonged LOS in univariable or multivariable analyses.
Discharge-anchored Δacute was not independently associated with prolonged LOS after accounting for baseline reserve and surgical context. Because both Δacute and LOS may be influenced by discharge timing and institutional practices, these findings do not establish that acute strength change reflects postoperative perturbation rather than intrinsic vulnerability.

PMID:
42619380
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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