Geriatric assessment as a predictor of delirium and other outcomes in elderly patients with cancer Journal Article
| Authors: | Korc-Grodzicki, B.; Sun, S. W.; Zhou, Q.; Iasonos, A.; Lu, B.; Root, J. C.; Downey, R. J.; Tew, W. P. |
| Article Title: | Geriatric assessment as a predictor of delirium and other outcomes in elderly patients with cancer |
| Abstract: | Objective: This study aimed to describe the implementation of preoperative geriatric assessment (GA) in patients undergoing major cancer surgery and to determine predictors of postoperative delirium. Background: Geriatric surgical patients have unique vulnerabilities and are at increased risk of developing postoperative delirium. Methods: Geriatricians at Memorial Sloan Kettering Cancer Center risk-stratify surgical patients with solid tumors, ages 75 years and older, using preoperative GA, which includes basic and instrumental activities of daily living (ADLs, IADLs), cognition (Mini-Cog test), history of falls, nutritional state, and comorbidities (Charlson Comorbidity Index). The Geriatrics Service evaluates patients for postoperative delirium using the confusion assessment method. A retrospective review was performed. The associations between GA and postoperative outcomes were evaluated. Univariate logistic regression analysis was performed to determine the predictive value of GA for postoperative delirium, and a multivariate model was built. Results: In total, 416 patients who received preoperative evaluation by the Geriatrics Service between September 1, 2010, and December 31, 2011, were included. Delirium occurred in 19% of patients. Patients with delirium had longer length of hospital stay (P < 0.001) and greater likelihood of discharge to a rehabilitation facility (P < 0.001). Charlson Comorbidity Index score, history of falls, dependent on IADL, and abnormal Mini-Cog test results predicted postoperative delirium on univariate analysis. Developed using a stepwise selection method, a multivariate model to predict delirium is presented including Charlson Comorbidity Index score (P = 0.032), dependence IADLs (P = 0.011), and falls history (P = 0.056). Conclusions: Preoperative GA is feasible and may achieve a better understanding of older patients' perioperative risks, including delirium. |
| Keywords: | age; complications; validation; geriatric assessment; united-states; assessment; preoperative; older-adults; noncardiac surgery; frailty; postoperative delirium; surgical task-force; geriatric surgical cancer patient |
| Journal Title: | Annals of Surgery |
| Volume: | 261 |
| Issue: | 6 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2015-06-01 |
| Start Page: | 1085 |
| End Page: | 1090 |
| Language: | English |
| ACCESSION: | WOS:000369611600037 |
| DOI: | 10.1097/sla.0000000000000742 |
| PROVIDER: | wos |
| PUBMED: | 24887981 |
| PMCID: | PMC4837653 |
| Notes: | Article -- Source: Wos |
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