Prevalence of perioperative functional disability using WHODAS 2.0 and associated adverse outcomes in surgical populations: A systematic review and meta-analysis

BACKGROUND: Functional disability affects a significant proportion of surgical patients. The World Health Organization Disability Assessment Schedule (WHODAS) version 2.0 is a validated measure of functional disability in surgical populations. This systematic review and meta-analysis uses the WHODAS to investigate the pooled prevalence of perioperative functional disability and its associated adverse postoperative outcomes. METHODS: A comprehensive literature search was conducted across multiple databases for studies published between January 2010 and July 13, 2024. The primary outcome was the prevalence of functional disability at perioperative time points among adult surgical patients. Functional disability was defined using the following WHODAS thresholds: ≥16% exceeded patient-acceptable levels, while ≥25% and ≥35% indicated clinically significant disability. RESULTS: Twenty studies (9,797 participants, mean age 70 ± 12 years, 38% female) were included in qualitative synthesis, with 14 included in meta-analysis. Pooled prevalence of preoperative functional disability exceeding patient-acceptable levels (WHODAS ≥ 16%) was 32% (95% CI: 23%, 42%). For clinically significant disability, preoperative prevalence was 34% (95% CI: 24%, 45%) using WHODAS ≥ 25% and 21% (95% CI: 11%, 35%) using WHODAS ≥ 35%. Postoperative prevalence of clinically significant disability (WHODAS ≥ 25%) decreased to 14% (95% CI: 8%, 23%) at 6 months and 15% (95% CI: 14%, 17%) at 12 months. Preoperative functional disability was associated with postoperative delirium, longer length of stay, non-home discharge, and greater postoperative pain. CONCLUSION: Functional disability is prevalent in surgical patients and associated with adverse outcomes. Identifying functional disability perioperatively assists in making informed decisions to optimize functionality and improve surgical outcomes. REGISTRATION: PROSPERO database under ID CRD42024574108 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024574108).