Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands.
Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands.
J Geriatr Oncol. 2018 Mar;9(2):110-114. doi: 10.1016/j.jgo.2017.09.003. Epub 2017 Nov 10.
Older patients are at risk for adverse outcomes after surgical treatment of cancer. Identifying patients at risk could affect treatment decisions and prevent functional decline. Screening tools are available to select patients for Geriatric Assessment. Until now their predictive value for adverse outcomes in older colorectal cancer patients has not been investigated.
To study the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) screening tools for adverse outcomes after elective colorectal surgery in patients older than 70years. Primary outcomes were 30-day complication rates, secondary outcomes were the length of hospital stay and six-month mortality.
Multicentre cohort study from two hospitals in the Netherlands. Frail was defined as a G8 ≤14 and/or ISAR-HP ≥2. Odds ratio (OR) is given with 95% CI.
Overall, 139 patients (52%) out of 268 patients were included; 32 patients (23%) were ISAR-HP-frail, 68 (50%) were G8-frail, 20 were frail on both screening tools. Median age was 77.7years. ISAR-HP frail patients were at risk for 30-day complications OR 2.4 (CI 1.1-5.4, p=0.03), readmission OR 3.4 (1.1-11.0), cardiopulmonary complications OR 5.9 (1.6-22.6), longer hospital stay (10.3 versus 8.9day) and six-months mortality OR 4.9 (1.1-23.4). When ISAR-HP and G8 were combined OR increased for readmission, 30-day and six-months mortality. G8 alone had no predictive value.
ISAR-HP-frail patients are at risk for adverse outcomes after colorectal surgery. ISAR-HP combined with G8 has the strongest predictive value for complications and mortality.
Patients screening frail on ISAR-HP are at increased risk for morbidity and mortality. Screening results of G8 alone was not predictive for postoperative outcomes. Predictive value increased when G8 and ISAR-HP were combined.
老年患者在接受癌症手术治疗后存在不良结局的风险。识别高危患者可能会影响治疗决策并防止功能下降。目前已有筛查工具用于选择接受老年综合评估的患者。但迄今为止，这些工具对老年结直肠癌患者不良结局的预测价值尚未得到研究。
研究老年 8 项（G8）和识别高危住院患者（ISAR-HP）筛查工具对 70 岁以上接受择期结直肠手术患者的不良结局的预测价值。主要结局是 30 天并发症发生率，次要结局是住院时间和 6 个月死亡率。
这是一项来自荷兰两家医院的多中心队列研究。 frail 定义为 G8≤14 和/或 ISAR-HP≥2。给出比值比（OR）及其 95%置信区间。
共有 268 例患者中的 139 例（52%）被纳入研究；32 例（23%）患者为 ISAR-HP-frail，68 例（50%）患者为 G8-frail，20 例患者两种筛查工具均显示 frail。中位年龄为 77.7 岁。ISAR-HP-frail 患者发生 30 天并发症的风险为 2.4（95%CI 1.1-5.4，p=0.03）、再入院的风险为 3.4（1.1-11.0）、心肺并发症的风险为 5.9（1.6-22.6）、住院时间更长（10.3 天 vs. 8.9 天）和 6 个月死亡率的风险为 4.9（1.1-23.4）。当同时结合 ISAR-HP 和 G8 时，再入院、30 天和 6 个月死亡率的风险增加。单独使用 G8 则没有预测价值。
ISAR-HP-frail 患者在结直肠手术后存在不良结局的风险。ISAR-HP 联合 G8 对并发症和死亡率具有最强的预测价值。
筛查出 ISAR-HP-frail 的患者发生发病率和死亡率增加。单独使用 G8 的筛查结果不能预测术后结局。当 G8 和 ISAR-HP 结合使用时，预测价值增加。
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