Weill Cornell Medical College, New York, NY, USA.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Geriatr Oncol. 2022 Mar;13(2):228-233. doi: 10.1016/j.jgo.2021.10.010. Epub 2021 Oct 28.
Older adults with head and neck cancer have increased postoperative complications, longer hospital stays, and higher rates of mortality. Geriatric assessment (GA) provides a measure of overall health status and is preferable to using age alone for assessing fitness for surgery. We sought to determine whether a patient's frailty as determined by a novel electronic GA is associated with outcomes after head and neck cancer (HNC) surgery.
We conducted a retrospective review of 159 patients aged 75 and older referred to the Geriatrics Service at Memorial Sloan Kettering Cancer Center for pre-operative evaluation prior to undergoing HNC surgery. All patients completed the electronic Rapid Fitness Assessment (eRFA) within 60 days prior to surgery. The accumulated geriatric deficit (AGD) score includes twelve domains from the eRFA with a point assigned for each domain in which there is a deficit and a final point related to comorbidities. Three other metrics were individually assessed: age, Karnofsky Performance Scale (KPS), and number of comorbidities. We utilized multivariable linear regression and t-tests to determine whether frailty is associated with longer length of hospital stay, 30-day intensive care unit (ICU) admission, and 30-day and 90-day postoperative mortality.
Patients with a higher AGD score spent more time in the hospital post-operatively (1.0 day increase per unit increase in AGD; 95% CI: 0.21-1.9; p = 0.015). Lower KPS was also associated with statistically significant longer length of stay (-2.70 day change per increasing index KPS; 95% CI: -4.30 - -1.00; days; p = 0.002), while age and comorbidity were not found to be statistically associated with length of stay. Higher AGD score remained significantly associated with longer length of stay on multivariable analysis (0.93 day increase per unit increase in AGD; 95% CI 0.15-1.71; p = 0.019). AGD was the only metric associated with increased risk of ICU admission (6.6 vs 5.0 geriatric deficits for those admitted vs not admitted to ICU; p = 0.024).
Frailty is associated with increased length of hospital stay and ICU admission in older adults with HNC undergoing surgery. GA can be used to counsel patients on the expected postoperative course.
头颈部癌症老年患者术后并发症更多、住院时间更长、死亡率更高。老年评估（GA）提供了整体健康状况的衡量标准，优于单独使用年龄来评估手术适应性。我们旨在确定通过新型电子 GA 确定的患者虚弱程度是否与头颈部癌症（HNC）手术后的结果相关。
我们对在 Memorial Sloan Kettering 癌症中心老年科接受术前评估的 159 名年龄在 75 岁及以上的头颈部癌症患者进行了回顾性研究。所有患者在手术前 60 天内完成了电子快速体能评估（eRFA）。累积老年缺陷（AGD）评分包括 eRFA 中的十二个领域，每个领域有一个缺陷得一分，最后与共病相关的一分。还单独评估了其他三个指标：年龄、卡诺夫斯基表现量表（KPS）和共病数量。我们利用多变量线性回归和 t 检验来确定虚弱是否与更长的住院时间、30 天重症监护病房（ICU）入院以及 30 天和 90 天术后死亡率相关。
AGD 评分较高的患者术后住院时间更长（AGD 每增加一个单位，住院时间增加 1.0 天；95%CI：0.21-1.9；p=0.015）。较低的 KPS 也与住院时间的显著延长相关（每增加一个指数 KPS，住院时间变化-2.70 天；95%CI：-4.30-1.00；天；p=0.002），而年龄和共病与住院时间无统计学关联。在多变量分析中，较高的 AGD 评分仍与更长的住院时间显著相关（AGD 每增加一个单位，住院时间增加 0.93 天；95%CI：0.15-1.71；p=0.019）。AGD 是唯一与 ICU 入院风险增加相关的指标（入住 ICU 与未入住 ICU 的患者的 AGD 缺陷分别为 6.6 和 5.0；p=0.024）。
虚弱与头颈部癌症老年患者手术治疗后的住院时间延长和 ICU 入院相关。GA 可用于告知患者术后预期的病程。
