eP431 - Fatigue and Mental Health in Older Patients After Major Abdominal Surgery

Purpose/Background: Older adults represent a growing proportion of surgical patients. Despite a growing interest in optimizing surgical care for these patients, little is known about their experience after surgery. Our goal was to better understand older adults’ experience with mental health and fatigue while recovering from major abdominal surgery.Methods/Interventions: This is a single center qualitative study of older adults who underwent major abdominal surgery at a tertiary referral center. We included English-speaking participants aged 65 and older, with length of stay at least 3 days, and ASA class 3 or higher. Semi-structured interviews were conducted between 1 and 4 months after surgery and focused on the experience of post-operative recovery. This preliminary analysis focused on mental health and fatigue. Participants completed a survey that further explored their recovery experience, functional status, and current mental and emotional health using the Decision Regret Scale, SF-12, PROMIS and FiND instruments. We performed thematic analysis on the interview transcripts using an inductive approach, as well as descriptive statistical analysis on survey data.Results/Outcomes: To date, we have enrolled 19 patients with a mean age of 72.2 years. 58% were male. Surgical procedure type was 32% colorectal, 16% small bowel, 16% stomach, 11% liver, 11% pancreas and 16% other (retroperitoneum, abdominal wall or diaphragm). 63% underwent open surgery and 37% underwent minimally invasive surgery. Interviews were conducted a mean of 92 days postoperatively. Eighteen patients (94.7%) completed the survey following the interview. Survey data showed that, due to their current health, 77.7% (14/18) of participants were limited in their physical activity and 66.7% (12/18) in their social activity. Additionally, 66.7% (12/18) of participants reported feeling depressed in the last week, 55.6% (10/18) reported feeling nervous, and 44.4% (8/18) reported feeling unhappy. Thematic analysis of the interview transcripts demonstrated that fatigue was a common symptom among participants after surgery, with the majority describing not only the severity of fatigue, but also their surprise in its impact. For example, one participant stated “I'm just weak, I didn’t have any energy at all. So, I didn't realize I'd be that way.” Another said, “I was really amazed at how long it took me to get my strength back”. The negative impact on mental and emotional health also emerged as a common theme among the majority of participants. Feelings of low mood, depression and irritability were common. For example, participants stated “I was pretty much...giving up on life” and “I’ve just lost interest. All I do is sleep". They also commonly described feelings of anxiety and worry with one participant sharing, “I'm just so nervous about everything right now...you don't know what's next."Conclusion/

Discussion: We found that older patients experience unexpected, significant fatigue and considerable negative effects on their emotional and mental health during recovery from major abdominal surgery. This was demonstrated in qualitative data from patient interviews and supported by patient survey data. Deliberate surgeon communication regarding fatigue preoperatively may improve expectations for patients about their recovery experience. Efforts to identify mood-related symptoms may allow for earlier intervention and improve outcomes post-operatively.