Division of Hematology and Oncology, University of California San Francisco, San Francisco, CA, USA.
Division of Geriatric & Palliative Medicine, University of Michigan, Ann Arbor, MI, USA.
J Geriatr Oncol. 2020 Jun;11(5):866-872. doi: 10.1016/j.jgo.2019.09.013. Epub 2019 Nov 4.
Comprehensive geriatric assessment prior to oncologic surgery can help predict surgical outcomes. We tested whether an abbreviated geriatric assessment tool, the Vulnerable Elderly Surgical Pathways and outcomes Assessment (VESPA), would predict post-operative complications among older adults undergoing oncologic surgery.
From 2008 to 2011, geriatric assessments were completed using the VESPA tool for patients age ≥ 70 seen in a pre-operative clinic. The VESPA assessed functional status, mood, cognition, and mobility, and can be completed in <10 min. We selected the subset of patients who underwent oncologic surgery and evaluated the VESPA's ability to predict post-operative surgical complications, geriatric complications (e.g., delirium), length of stay, and geriatric post-discharge needs (e.g., new functional dependence).
A total of 476 patients who underwent oncologic surgery received the assessment using VESPA. Compared to patients with low VESPA scores (<9), patients with high VESPA scores (≥9) had longer length of stay (mean 6.6 vs. 2.0 days; p < .001), more geriatric complications (39.5% vs. 5.7%; p < .001), more surgical complications (29.5% vs. 11.8%; p < .001), and more likely to have post discharge needs (76.0% vs. 31.7%; p < .001). Using logistic regression, each additional point on the VESPA scale was also associated with increased probability of geriatric complications (OR = 1.3; 95% CI = 1.2-1.4), surgical complications (OR = 1.2; 95% CI = 1.1-1.2), and geriatric post-discharge needs (OR = 1.3; 95% CI = 1.2-1.3).
The VESPA identifies older patients with cancer who are at risk for postoperative surgical and geriatric complications as well as functional needs at hospital discharge.
在肿瘤外科手术前进行全面老年评估有助于预测手术结果。我们测试了一种简化的老年评估工具，即脆弱老年人手术途径和结果评估(VESPA)，是否可以预测接受肿瘤外科手术的老年人术后并发症。
2008 年至 2011 年，在术前诊所对年龄≥70 岁的患者使用 VESPA 工具进行老年评估。VESPA 评估了功能状态、情绪、认知和移动能力，可在 10 分钟内完成。我们选择了接受肿瘤外科手术的患者子集，并评估了 VESPA 预测术后手术并发症、老年并发症（如谵妄）、住院时间和老年出院后需求（如新的功能依赖）的能力。
共有 476 名接受肿瘤外科手术的患者接受了 VESPA 评估。与 VESPA 评分较低（<9）的患者相比，VESPA 评分较高（≥9）的患者住院时间更长（平均 6.6 天 vs. 2.0 天；p<0.001），老年并发症更多（39.5% vs. 5.7%；p<0.001），手术并发症更多（29.5% vs. 11.8%；p<0.001），出院后需求的可能性更高（76.0% vs. 31.7%；p<0.001）。使用逻辑回归，VESPA 评分每增加 1 分，老年并发症（OR=1.3；95%CI=1.2-1.4）、手术并发症（OR=1.2；95%CI=1.1-1.2）和老年出院后需求（OR=1.3；95%CI=1.2-1.3）的可能性也会增加。
VESPA 确定了患有癌症的老年患者，这些患者有术后手术和老年并发症以及出院时功能需求的风险。
