The prognostic value of a geriatric risk score for older patients undergoing emergency surgery of colorectal cancer: A retrospective cohort study.

Autor: Hultink D; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands. Electronic address: daniellehultink@hotmail.com., Souwer ETD; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands., Bastiaannet E; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands., Dekker JT; Department of Surgery, Reinier De Graaf Gasthuis, Delft, the Netherlands., Steup WH; Department of Surgery, Haga Hospital, The Hague, the Netherlands., Hamaker ME; Department of Geriatric Medicine, Diakonessenhuis, Utrecht, the Netherlands., Sonneveld DJA; Department of Surgery, Dijklander Ziekenhuis Hoorn, the Netherlands., Consten ECJ; Department of Surgery, Meander Medisch Centrum, Amersfoort, the Netherlands., Neijenhuis PA; Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands., Portielje JEA; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands., van den Bos F; Department of Geriatric Medicine, University Medical Center Leiden, Utrecht, the Netherlands.
Jazyk: angličtina
Zdroj: Journal of geriatric oncology [J Geriatr Oncol] 2024 Mar; Vol. 15 (2), pp. 101711. Date of Electronic Publication: 2024 Feb 03.
DOI: 10.1016/j.jgo.2024.101711
Abstrakt: Introduction: Emergency surgery of colorectal cancer is associated with high mortality rates in older patients. We investigated whether information on four geriatric domains has prognostic value for 30-day mortality and postoperative morbidity including severe complications.
Materials and Methods: All consecutive patients aged 70 years or older who underwent emergency colorectal cancer surgery in six Dutch hospitals (2014-2017) were studied. Presence of geriatric risk factors was scored prior to surgery as either 0 (risk absent) or 1 (risk present) in each of four geriatric domains and summed up to calculate a sumscore with a value between 0 and 4. In addition, we separately investigated the use of a mobility aid. Primary outcome was 30-day mortality. Secondary outcomes were any postoperative complications and severe complications. Multivariable logistic regression model was used to evaluate the sumscore and outcomes.
Results: Two hundred seven patients were included. Median age was 79.4 years. One hundred seventy-five patients (76%) presented with obstruction, 22 (11%) with a perforation, and 17 (8%) with severe anemia. Mortality rates were 2.9%, 13.6%, and 29.6% for patients with a sumscore of 0, 1-2, and 3-4 respectively, with odds ratio (OR) 4.8 [95% confidence interval (CI) 1.03-22.95] and OR 10.6 [95% CI 1.99-56.34] for a sumscore of 1-2 and 3-4 respectively. Use of a mobility aid was associated with increased mortality OR 8.0 [95% CI 2.74-23.43] and severe complications OR 2.31 [95% CI 1.17-4.55].
Discussion: This geriatric sumscore and the use of a mobility aid have strong association with 30-day mortality after emergency surgery of colorectal cancer. This could provide better insight into surgical risk and help select high-risk patients for alternative strategies.
Competing Interests: Declaration of competing interest None.
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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