Colorectal Carcinoma in the Frail Surgical Patient. Implementation of a Work Area Focused on the Complex Surgical Patient Improves Postoperative Outcome

Valls, Jordi Castellví; Brau, Núria Borrell; Bernat, María José; Iglesias, Patricia; Reig, Lluís; Pascual, Lluís; Vendrell, Marina; Santos, Pilar; Viso, Lorenzo; Farreres, Núria; Galofré, Gonzalo; Deiros, Carmen; Barrios, P.

doi:10.1016/j.cireng.2017.09.015

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…Castellví Valls et al report outcomes in frail patients undergoing radical surgery for colorectal cancer under the care of a ‘Complex Surgical Patient Care Area’ multidisciplinary team to optimise patients pre‐, intra‐and post‐operatively. They demonstrated a significant reduction in length of stay, 30‐day re‐admission and complications (CD I–II/III–IV) in the intervention group 13 …”

Section: Resultsmentioning

confidence: 93%

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The impact of frailty on clinical outcomes in colorectal cancer surgery: a systematic literature review

Maturana

English

Nandakumar

et al. 2021

ANZ Journal of Surgery

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Background The majority of colorectal cancer is diagnosed in people aged >65 years, yet the elderly are less likely to undergo curative surgery. Chronological age is poorly correlated with post‐operative outcomes and is not an acceptable measure of risk. Conversely, frailty is a strong predictor of poor post‐operative outcomes and presents an opportunity for optimisation. This systematic review aims to assess the evidence between frailty and outcomes in patients of all ages undergoing colorectal cancer resections and to compare the predictive value of frailty status to that of age alone. Methods The review was registered on Prospero, CRD42019150542. PubMed was searched for articles reporting outcomes for frail patients undergoing elective or emergency colorectal cancer resection up until August 2019. All studies reporting outcomes in frail patients were deemed eligible for inclusion and assessed according to the PRISMA guidelines. Results Of the 143 identified studies, 17 were eligible for inclusion. Study type, frailty assessments and outcomes measured were highly variable. ‘Frailty’ was associated with significantly higher rates of post‐operative complications (7/7 studies), post‐operative mortality (5/7 studies), readmission (3/4 studies) and length of stay (3/3 studies). Seven of 11 studies reported no association between age and adverse outcomes. Conclusion Frailty is a predictor of poor clinical outcomes in patients undergoing surgery for colorectal cancer. Standardisation of frailty assessment and outcome measure is needed. Accurate risk stratification of patients will allow us to make informed treatment decisions, identify patients who may benefit from preoperative intervention and tailor post‐operative care.

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Section: Resultsmentioning

confidence: 93%

“…The literature search (Fig. S1) produced 143 records, 39 of these were eligible for full‐text review and a total of 17 studies were included in the review 3,10–25 . The study characteristics are described in Table 1.…”

Section: Resultsmentioning

confidence: 99%

The impact of frailty on clinical outcomes in colorectal cancer surgery: a systematic literature review

Maturana

English

Nandakumar

et al. 2021

ANZ Journal of Surgery

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“…Evidence suggests the best application of the CGA is within appropriately identified patients, though currently, there are no validated criteria indicating which patients are most likely to benefit (Ward & Reuben, 2021). However, there is an increasing body of research supporting the use of a targeted model of care, based on the CGA applied in the peri‐operative period, to improve outcomes for older frail surgical patients (Castellvi Valls et al, 2018; Chia et al, 2016; Hempenius et al, 2013; Ommundsen et al, 2018). Our findings further highlight the need for frailty to be routinely recognised in the surgical setting, as part of the planning of care and evaluation of patient outcomes to align with the increased risk of adverse events among hospitalised older frail patients.…”

Section: Discussionmentioning

confidence: 99%

Frailty among older surgical patients and risk of hospital acquired adverse events: The South‐Western Sydney frailty and nurse sensitive indicators study

McEvoy

Richter

Chen

et al. 2022

Journal of Clinical Nursing

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Background While advances in healthcare mean people are living longer, increasing frailty is a potential consequence of this. The relationship between frailty among older surgical patients and hospital acquired adverse events has not been extensively explored. We sought to describe the relationship between increasing frailty among older surgical patients and the risk of hospital acquired adverse events. Methods We included consecutive surgical admissions among patients aged 70 years or more across the SWSLHD between January 2010 and December 2020. This study used routinely collected ICD‐10‐AM data, obtained from the government maintained Admitted Patient Data Collection. The relationships between cumulative frailty deficit items and risk of hospital acquired adverse events were assessed using Poisson regression modelling. This study followed the RECORD/STROBE guidelines. Results During the study period, 44,721 (57% women) older adults were admitted, and 41% (25,306) were planned surgical admissions. The risk of all adverse events increased with increasing number of frailty deficit items, the highest deficit items group (4–12 deficit items) compared with the lowest deficit items group (0 or 1 deficit item): falls adjusted rate ratio (adj RR) = 15.3, (95% confidence interval (CI) 12.1, 19.42); pressure injury adj RR = 21.3 (95% CI 12.53, 36.16); delirium adj RR = 40.9 (95% CI 31.21, 53.55); pneumonia adj RR = 16.5 (95% CI 12.74, 21.27); thromboembolism adj RR = 17.3 (95% CI 4.4, 11.92); and hospital mortality adj RR = 6.2 (95% CI 5.18, 7.37). Conclusion The increase in number of cumulative frailty deficit items among older surgical patients was associated with a higher risk of adverse hospital events. The link offers an opportunity to clinical nursing professionals in the surgical setting, to develop and implement targeted models of care and ensure the best outcomes for frail older adults and their families.

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“…Fragility scores should be used such as the Modified Frailty Index and VIG Express and the Beers criteria should be reviewed for preventing delirium in adults over 65 years old. Despite the fact that there is no perfect score, any score is better than none [22][23][24][25][26].…”

Section: Preoperative Phasementioning

confidence: 99%

The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for perioperative care

Ioannidis¹,

Ramírez-Rodríguez²,

Ubieto³

et al. 2023

Preprint

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Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate.

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Colorectal Carcinoma in the Frail Surgical Patient. Implementation of a Work Area Focused on the Complex Surgical Patient Improves Postoperative Outcome

Cited by 8 publications

References 29 publications

The impact of frailty on clinical outcomes in colorectal cancer surgery: a systematic literature review

The impact of frailty on clinical outcomes in colorectal cancer surgery: a systematic literature review

Frailty among older surgical patients and risk of hospital acquired adverse events: The South‐Western Sydney frailty and nurse sensitive indicators study

The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for perioperative care

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