Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.
Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Ann Surg Oncol. 2019 Jan;26(1):71-78. doi: 10.1245/s10434-018-6867-x. Epub 2018 Oct 25.
VMS is a Dutch risk assessment tool for hospitalized older adults that includes a short evaluation of four geriatric domains: risk for delirium, risk for undernutrition, risk for physical impairments, and fall risk. We investigated whether the information derived from this tool has prognostic value for outcomes of colorectal surgery.
All consecutive patients over age 70 years who underwent elective colorectal cancer surgery in three Dutch hospitals (2014-2016) were studied. The presence of risk was scored prior to surgery and per geriatric domain as either 0 (risk absent) or 1 (risk present). The total number of geriatric risk factors was summed. The primary outcome was long-term survival. Secondary outcomes were postoperative complications, including delirium. Cox proportional hazards models were used to evaluate the sumscore and risk factors associated with overall survival.
Five hundred fifty patients were included. Median age was 76.5 years, and median follow-up was 870 days. Patients with intermediate (1-2) or high (3-4) sumscore were independently associated with lower overall survival, with hazard ratio (HR) of 1.9 [95% confidence interval (CI) 1.1-3.5; p = 0.03] and 8.7 (95% CI 4.0-19.2; p < 0.001), respectively. Sumscores were also associated with postoperative complications (intermediate sumscore OR 1.8; 95% CI 1.2-2.7; high sumscore OR 2.4; 95% CI 1.02-5.5).
This easy-to-use geriatric sumscore has strong associations with long-term outcome and morbidity after colorectal cancer surgery. This information may be included in risk models for morbidity and mortality and can be used in shared decision-making.
VMS 是一种荷兰风险评估工具，用于评估住院老年患者，包括对四个老年科领域的简要评估：谵妄风险、营养不良风险、身体损伤风险和跌倒风险。我们研究了该工具提供的信息是否对结直肠手术结果具有预后价值。
所有在荷兰三家医院接受择期结直肠癌手术的 70 岁以上患者（2014-2016 年）均参与研究。在手术前和每个老年科领域评估风险，评分分别为 0（无风险）或 1（有风险）。将所有老年科风险因素相加得到总评分。主要结局为长期生存。次要结局为术后并发症，包括谵妄。使用 Cox 比例风险模型评估总评分和与总生存相关的风险因素。
共纳入 550 例患者。中位年龄为 76.5 岁，中位随访时间为 870 天。中危（1-2 分）或高危（3-4 分）总评分的患者与总生存率降低独立相关，风险比（HR）分别为 1.9（95%可信区间 [CI] 1.1-3.5；p=0.03）和 8.7（95%CI 4.0-19.2；p<0.001）。总评分也与术后并发症相关（中危总评分 OR 1.8；95%CI 1.2-2.7；高危总评分 OR 2.4；95%CI 1.02-5.5）。
这种易于使用的老年科总评分与结直肠癌手术后的长期结局和发病率密切相关。该信息可纳入发病率和死亡率的风险模型，并可用于共同决策。
