Evaluation of The Comprehensive Geriatric Assessment (CGA) Tool As A Predictor of Postoperative Complications Following Major Oncological Abdominal Surgery in Older Patients

Abstract

Purpose: The concept of frailty extends beyond chronological age. Identifying frailty using a two-step approach, starting with the use of a screening tool (G8) followed by complete geriatric assessment (CGA), may be useful for guiding treatment decisions and follow-up.This study evaluated the association between geriatric screening and individual components of the tCGA with the risk of 90-day postoperative complications in oncogeriatric patients.Methods: Data on patients with major oncological abdominal surgery were retrospectively collected from hospital records (2016-2019). Patients with G8 and CGA geriatric screening in those identified by an altered G8 screening score were included. Postoperative complications were classified by Clavien-Dindo grade and the Comprehensive Complication Index (CCI).Results: One hundred and twelve patients aged ≥ 70 years surgically treated with curative intent for cancer were included. Seventy-six (67.9%) presented with an altered G8. Of these, sixty-six (58.9%) had a CGA. In univariate analysis, only altered nutritional status assessed by the Mini-Nutritional Assessment-Short Form was associated with higher total complication rate (p = 0.01). Patients with impaired G8 had significantly more complications and higher 1-year mortality rates than patients with normal G8. Fifteen patients (13.4%) had grade III-IVb complications. A CCI > 50 was recorded in 16 patients (14.3%). All-cause 90-day postoperative mortality was 10.7%.Conclusions: Identifying altered preoperative nutritional status as part of the CGA in patients screening positive for frailty is a potentially modifiable risk factor that can influence preoperative management and treatment decision making. G8 may be a predictive factor for postoperative complications.