Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery

Kim, Kwang Il; Park, Kay-Hyun; Koo, Kyung‐Hoi; Han, Ho‐Seong; Kim, Cheol-Ho

doi:10.1016/j.archger.2012.09.002

Cited by 133 publications

(91 citation statements)

References 23 publications

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“…(13) Though formal research on geriatric risk indices in surgery is still in its infancy, there is evidence of their association with in-hospital occurrences, total length of stay, post-discharge institutionalization, and mortality. (9, 33–36) One concern is that comprehensive geriatric assessment (e.g., performing all domains of assessment) is not feasible in a busy surgical preoperative practice and the assessments are likely performed with less reliability in this setting compared to prior formal research studies. (6, 33, 37, 38) TPA is also correlated with postoperative outcomes, including length of stay, payer costs, surgical complication rate, and mortality.…”

Section: Discussionmentioning

confidence: 99%

Analytic morphomics corresponds to functional status in older patients

Miller¹,

Min²,

Diehl³

et al. 2014

Journal of Surgical Research

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Background Older patients account for nearly half of U.S. surgical volume and age alone is insufficient to predict surgical fitness. Various metrics exist for risk stratification, but little work has been done to describe the association between measures. We aimed to determine whether analytic morphomics, a novel objective risk assessment tool, correlates with functional measures currently recommended in the preoperative evaluation of older patients. Materials and Methods We retrospectively identified 184 elective general surgery patients over age 70 with both a preoperative CT scan and Vulnerable Elderly Surgical Pathways and outcomes Assessment (VESPA) within 90 days of surgery. We used analytic morphomics to calculate trunk muscle size (total psoas area, or TPA) and univariate logistic regression to assess the relationship between TPA and domains of geriatric function – mobility, basic and instrumental activities of daily living (ADL), and cognitive ability. Results Greater TPA was inversely correlated with impaired mobility (OR=0.46, 95% C.I. 0.25–0.85, P=0.013). Greater TPA was associated with decreased odds of deficit in any basic ADLs (OR=0.36 per SD unit increase in TPA, 95% C.I. 0.15–0.87, P<0.03) and any instrumental ADLs (OR=0.53, 95% C.I. 0.34–0.81; P<0.005). Finally, patients with larger TPA were less likely to have cognitive difficulty assessed by Mini-Cog scale (OR=0.55, 95% C.I. 0.35–0.86, P<0.01). Controlling for age did not change results. Conclusions Older surgical candidates with greater trunk muscle size, or greater TPA, are less likely to have physical impairment, cognitive difficulty, or decreased ability to perform daily self-care. Further research linking these assessments to clinical outcomes is needed.

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Section: Discussionmentioning

confidence: 99%

Analytic morphomics corresponds to functional status in older patients

Miller¹,

Min²,

Diehl³

et al. 2014

Journal of Surgical Research

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“…Previous studies of elderly patients used the Comprehensive Geriatric Assessment (CGA), a tool that has been proven to predict both mortality and disability [2,3,5,6,10]. One CGA model found to correlate with poor outcomes is composed of eight domains: Katz Index of Independence in Activities of Daily Living (ADL), Lawton Instrumental Activities of Daily Living Scale (IADL), cognition, depression, fall risk, nutrition, polypharmacy, and social support [5].…”

Section: Introductionmentioning

confidence: 99%

Preoperative impairment is associated with a higher postdischarge level of care

Ehlenbach

Tevis

Kennedy

et al. 2015

Journal of Surgical Research

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Background Although preoperative risk factors have been shown to lead to postdischarge institutionalization, an association between preoperative risk factors, preoperative level of required care, and discharge to higher levels of care has not previously been demonstrated. Materials and methods Using an institutional American College of Surgeons National Surgical Quality Improvement Program database, a retrospective review of elderly patients undergoing nonemergent inpatient general surgery procedures was performed with the goal of identifying preoperative risk factors that indicated the need for a higher level of care on hospital discharge. Univariate and multivariate analyses were performed on the patient population. Results Over a 4-y period, 585 patients (29%) within the database were aged ≥65 y. In this population, 12% of patients required discharge to a higher level of care compared with their preoperative origin. In patients aged ≥65 y, impaired cognition, decreased functional capacity, advanced age (≥79 y), high American Society of Anesthesiologists class, and long hospital length of stay were found in univariate analysis to be associated with postoperative discharge to a higher level of care, although all of these variables except decreased functional capacity were also associated with a higher discharge level of care in multivariate analysis. Conclusions Cognitive and functional capacity scoring can be used as simple ways to indicate discharge to a higher level of care for older adults. Preoperative counseling in high-risk older adults needs to include the likelihood for discharge to a higher level of care, so that a possible referral to social work can be placed during discharge planning.

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“…Instruments used for CGA, covering the assessment of nutrition, cognitive ability, and physical disability, promise to markedly improve the selection of elderly patients for TAVI. Several reports have shown that such an evaluation leads to longer survival, earlier discharge, better clinical outcome, shorter institutional care [8,9,[14][15][16]. Actually, since all candidates for TAVI are elderly patients, the initial clinical evaluation should however determine those requiring further additional geriatric evaluation.…”

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confidence: 96%

Management of severe aortic stenosis: The geriatrician takes his flight

Cribier

2015

European Geriatric Medicine

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Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery

Cited by 133 publications

References 23 publications

Analytic morphomics corresponds to functional status in older patients

Analytic morphomics corresponds to functional status in older patients

Preoperative impairment is associated with a higher postdischarge level of care

Management of severe aortic stenosis: The geriatrician takes his flight

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