Geriatric Assessment as a Predictor of Delirium and Other Outcomes in Elderly Patients With Cancer

Abstract

Objective This study aimed to describe the implementation of preoperative geriatric assessment (GA) in patients undergoing major cancer surgery and to determine predictors of postoperative delirium. Summary Background Data Geriatric surgical patients have unique vulnerabilities and are at increased risk of developing postoperative delirium. Methods Geriatricians at Memorial Sloan Kettering Cancer Center risk-stratify surgical patients with solid tumors, aged ≥ 75 years using preoperative GA, which includes basic and instrumental activities of daily living (ADLs, IADLs), cognition (Mini-Cog Test), history of falls, nutritional state, and comorbidities (Charlson Comorbidity Index [CCI]). The Geriatrics Service evaluates patients for postoperative delirium using the Confusion Assessment Method (CAM). A retrospective review was performed. The associations between GA and postoperative outcomes were evaluated. Univariate logistic regression analysis was performed to determine the predictive value of GA for postoperative delirium, and a multivariate model was built. Results In total, 416 patients who received preoperative evaluation by the Geriatrics Service between September 1, 2010, and December 31, 2011, were included. Delirium occurred in 19% of patients. Patients with delirium had longer length of hospital stay (P<0.001) and greater likelihood of discharge to a rehabilitation facility (P<0.001). CCI score, history of falls, dependent on IADL, and abnormal Mini-Cog Test results predicted postoperative delirium on univariate analysis. Developed using a stepwise selection method, a multivariate model to predict delirium is presented including CCI score (P=0.032), dependence IADLs (P=0.011) and falls history (P=0.056). Conclusions Preoperative GA is feasible and may achieve a better understanding of older patients’ perioperative risks, including delirium.

Postoperative Delirium in Patients after Pancreaticoduodenectomy

“…The Charlson Comorbidity Index has been widely used as one of the validated tools to classify comorbidity conditions [30] . POD is also evaluated by using the Charlson Comorbidity Index [14,22,28,42] . We adopted this validated tool as a comorbidity-weighted system.…”

Hemodynamic Control and Delirium

“…In a recent study in elderly hip fracture patients, patients with postoperative delirium were found more likely to die, to be diagnosed with dementia or mild cognitive impairment, or to require institutionalization [26]. Furthermore, patients with more comorbidities, lower independence scores, a history of falls, and lower cognitive scores were significantly more likely to develop postoperative delirium in a recent study in 416 patients [20]. Postoperative delirium has been reported to occur soon after surgery [27], and the duration of postoperative delirium was an independent predictor of 6-months mortality in older adults after hip fracture in one study [28].…”

“…Postoperative delirium is a serious problem for hospitalized geriatric patients [6, 10 •• , 12]. Postoperative delirium is associated with significant increases in functional disability, length of hospital stay, rates of admission to long-term care institutions, and rates of death [1,6,9,[13][14][15][16][17][18][19][20][21]. Patients who developed postoperative delirium required a hospital stay approximately four times longer than those who remained lucid [22].…”

4th Symposium on Primary Breast Cancer in Older Women. Theme: Putting Personalized Care Into Practice (Held: 3 March 2017)

“…What Robinson et al discovered was that impaired cognition, recent falls, low albumin and low hemoglobin, as well as functional dependency and increased comorbidities are risk factors for 6-month mortality and postdischarge institutionalization. KorcGrodzicki mentioned that in her institution, they demonstrated that patients who are 75 years or older who have major cancer surgeries that require >1 day of hospitalization, when they have multimorbidity, functional dependency and a history of falls, have an increased risk for postoperative delirium, increased length of stay and discharge to rehabilitation [37].…”