Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer
| Autor: | Farnia Amirnia, Andrew J. Vickers, Beatriz Korc-Grodzicki, Heidi Yulico, Sincere McMillan, Armin Shahrokni, Steve Sun, Koshy Alexander, Soo Jung Kim, Robert J. Downey, Saman Sarraf, Amy Tin |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Health Services for the Aged Collaborative Care Preoperative care Anesthesiology Neoplasms medicine Humans Physical Therapy Modalities Original Investigation Aged Retrospective Studies Geriatrics Aged 80 and over business.industry Research Retrospective cohort study General Medicine Emergency department Perioperative Length of Stay Online Only Elective Surgical Procedures Emergency medicine Female Nutrition Therapy business Cohort study |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | Key Points Question Is collaboration between geriatricians and surgeons in the perioperative care of older patients with cancer associated with postoperative outcomes? Findings In this cohort study including 1892 patients aged 75 years and older, the adjusted probability of death within 90 days after surgery was 4.3% for patients who received geriatric comanagement of care, compared with 8.9% for patients who received care management from the surgical service only. Meaning These findings suggest that when feasible, older patients undergoing surgical treatment for cancer should receive geriatric care comanagement as part of their perioperative care. This cohort study examines outcomes associated with geriatric comanaged perioperative care vs care managed by the surgery team alone among patients aged 75 years and older with cancer. Importance Collaboration between geriatricians and surgeons in the perioperative treatment of older patients has been associated with improved outcomes in several nononcologic specialties. Similar associations may be possible among older patients with cancer. Objective To investigate the associations of geriatric comanagement of care for older patients undergoing cancer-related surgical treatment with 90-day postoperative mortality, rate of adverse surgical events, and postoperative use of inpatient supportive care services. Design, Setting, and Participants This retrospective cohort study assessed outcomes of patients who received geriatric comanaged care vs those who did not using multivariable logistic regression analysis, with 90-day mortality as the outcome and geriatric comanagement of care as the main variable, with adjustment for age, sex, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index score, preoperative albumin level, operative time, and estimated blood loss. A similar model was used to assess the association of geriatric comanagement with adverse surgical events, defined as any major complication, readmission, or emergency department visit within 30 days. Patients aged 75 years and older who underwent an elective surgical procedure with a hospital stay of at least 1 day at a single tertiary-care cancer center between February 2015 and February 2018 were included. Data were analyzed from January to July 2019. Exposures Postoperative care comanaged by the geriatrics service and surgical service (geriatric comanagement group) vs by the surgical service only (surgical service group). Main Outcomes and Measures 90-day mortality, adverse surgical events, and use of supportive care services. Results Of 1892 patients included, 1020 (53.9%) received geriatric comanagement of care; these patients, compared with those who received care managed by the surgery service only, were older (mean [SD] age, 81 [4] years vs 80 [4] years; P |
| Databáze: | OpenAIRE |
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