Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Data Centre and Statistics Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium.
PLoS One. 2022 Mar 3;17(3):e0264790. doi: 10.1371/journal.pone.0264790. eCollection 2022.
The concept of frailty extends beyond chronological age. Identifying frailty using a two-step approach, starting with the use of a screening tool (G8) followed by comprehensive geriatric assessment (CGA), may be useful in guiding treatment decisions and follow-up. This study evaluated the association between G8 and CGA, and the risk of 90-day postoperative complications risk, in oncogeriatric patients.
Data on geriatric patients with major oncological abdominal surgery was retrospectively collected from our hospital records between 2016 and 2019. Patients with an impaired G8 screening score, who subsequently underwent CGA geriatric screening, were included. Postoperative complications were classified using the Clavien-Dindo classification (CD), and the Comprehensive Complication Index (CCI). The association between the individual components of the geriatric assessment tools and the 90-day postoperative complications risk was analyzed.
One hundred and twelve patients, aged ≥ 70 years, operated for an intra-abdominal tumor with curative intent, were included. Seventy-six patients (67.9%) presented with an impaired G8, out of whom sixty-six (58.9%) had a CGA performed. On univariate analysis, altered nutritional status assessed by the Mini-Nutritional Assessment-Short Form was the only variable associated with higher postoperative total complication rate (p = 0.01). Patients with an impaired G8 had significantly more postoperative complications and higher 1-year mortality rates than patients with normal G8. Fifteen patients (13.4%) had grade III-IVb complications. A CCI > 50 was recorded in 16 patients (14.3%). All-cause 90-day postoperative mortality was 10.7%.
Identifying an altered preoperative nutritional status, as part of the CGA, in patients screening positive for frailty, is a potentially modifiable risk factor that can enhance preoperative management and optimize treatment decision making. G8 may be a predictive factor for postoperative complications in oncogeriatric patients.
虚弱的概念不仅超越了年龄。使用两步法（首先使用筛选工具[G8]，然后进行全面老年评估[CGA]）确定虚弱状态，可能有助于指导治疗决策和随访。本研究评估了 G8 与 CGA 之间的关联，以及对老年肿瘤患者 90 天术后并发症风险的影响。
回顾性收集了 2016 年至 2019 年期间我院记录的接受主要腹部肿瘤手术的老年患者的老年医学数据。纳入 G8 筛查评分受损、随后进行 CGA 老年筛查的患者。术后并发症采用 Clavien-Dindo 分类（CD）和综合并发症指数（CCI）进行分类。分析老年评估工具的各个组成部分与 90 天术后并发症风险的关系。
共纳入 112 例年龄≥70 岁、接受根治性腹部肿瘤手术的患者。76 例（67.9%）患者 G8 评分受损，其中 66 例（58.9%）接受了 CGA。单因素分析显示，Mini-Nutritional-Assessment-Short Form 评估的营养状态改变是与更高术后总并发症发生率相关的唯一变量（p=0.01）。G8 评分受损的患者术后并发症发生率和 1 年死亡率明显高于 G8 评分正常的患者。15 例（13.4%）患者发生 3-4b 级并发症。16 例（14.3%）患者记录 CCI＞50。全因 90 天术后死亡率为 10.7%。
在对虚弱状态进行筛查的患者中，CGA 中发现的术前营养状态改变是一个潜在的可改变的危险因素，可以增强术前管理并优化治疗决策。G8 可能是老年肿瘤患者术后并发症的预测因素。
