Geriatric Assessment as a Predictor of Delirium and Other Outcomes in Elderly Patients With Cancer. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Korc-Grodzicki, Beatriz; Sun, Sung W.; Zhou, Qin; Iasonos, Alexia; Lu, Bryan; Root, James C.; Downey, Robert J.; Tew, William P.
• Is Part Of: Annals of surgery. Volume 261:Issue 6(2015:Jun.)
• Publication Date: 2015-06
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000742
• Languages: English
• ISSNs: 0003-4932

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>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.</p> </sec> <sec> <title>Background:</title> <p>Geriatric surgical patients have unique vulnerabilities and are at increased risk of developing postoperative delirium.</p> </sec> <sec> <title>Methods:</title> <p>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.</p> </sec> <sec> <title>Results:</title> <p>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 (<italic>P</italic> < 0.001) and greater likelihood of discharge to a rehabilitation facility (<italic>P</italic> < 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 (<italic>P</italic> = 0.032), dependence IADLs (<italic>P</italic> = 0.011), and falls history (<italic>P</italic> = 0.056).</p> </sec> <sec> <title>Conclusions:</title> <p>Preoperative GA is feasible and may achieve a better understanding of older patients' perioperative risks, including delirium.</p> </sec> </abstract>