Department of Neurobiology, Care Sciences and Society, both at Karolinska Institute, Stockholm, Sweden; Subject Aging, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Centre for Digestive Diseases, Karolinska University Hospital Solna, Stockholm, Sweden.
J Geriatr Oncol. 2019 Sep;10(5):709-715. doi: 10.1016/j.jgo.2019.01.020. Epub 2019 Feb 8.
We investigated the predictive value of specific tools used in a Comprehensive Geriatric Assessment (CGA) with regard to postoperative outcome in patients 75 years and older undergoing elective colorectal cancer (CRC) surgery. Furthermore, recovery was followed over the first postoperative year using the same assessment tools.
Baseline clinical and CGA variables including functional and nutritional status, pressure sore risk, fall risk, cognition, depression, polypharmacy, comorbidity, and health-related quality-of-life (HRQoL) were prospectively recorded. Outcome variables were postoperative complications and length of stay (LOS). Patients were likewise followed up at one, three and twelve months postoperatively.
Forty-nine patients underwent surgery (median age 81 years). Forty-three per cent had ASA (American Society of Anesthesiologists) class 2 47% had ASA class 3. Postoperative complications occurred in 32.7%. Median LOS was eight days. In univariate analyses, none of the parameters tested predicted postoperative complication or LOS. During follow-up, all patients recovered to baseline values apart from HRQoL which was still reduced at three and twelve months (p = .017). Nutritional status had improved twelve months after surgery (p = .011).
No association could be found in this study between the results of a comprehensive geriatric assessment and prolonged length of stay or postoperative complication rate after elective surgery for colorectal cancer. Patients recovered well during the first year after surgery. Quality of life, however, was still lower than prior to surgery.
我们研究了综合老年评估（CGA）中使用的特定工具对 75 岁及以上接受择期结直肠癌（CRC）手术患者的术后结果的预测价值。此外，使用相同的评估工具在术后第一年对患者进行了恢复情况的随访。
前瞻性记录基线临床和 CGA 变量，包括功能和营养状况、压疮风险、跌倒风险、认知、抑郁、多药治疗、合并症和健康相关生活质量（HRQoL）。术后并发症和住院时间（LOS）是观察的结果变量。同样在术后 1、3 和 12 个月对患者进行了随访。
49 例患者接受了手术（中位年龄 81 岁）。43%的患者为美国麻醉医师协会（ASA）分级 2，47%为 ASA 分级 3。术后并发症发生率为 32.7%。中位 LOS 为 8 天。在单变量分析中，未发现测试的任何参数可预测术后并发症或 LOS。在随访期间，所有患者除 HRQoL 外均恢复至基线值，而 HRQoL 在术后 3 个月和 12 个月仍降低（p=0.017）。营养状况在手术后 12 个月得到改善（p=0.011）。
在这项研究中，综合老年评估的结果与择期结直肠癌手术后的住院时间延长或术后并发症发生率之间没有关联。患者在手术后的第一年恢复良好。然而，生活质量仍低于手术前。
