老年共管理对接受胃肠癌手术的老年患者的影响：一项回顾性、前后对照研究。
Effect of Geriatric Comanagement in Older Patients Undergoing Surgery for Gastrointestinal Cancer: A Retrospective, Before-and-After Study.
机构信息
Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Unit of Surgical Oncology, San Martino Hospital, Genoa, Italy.
出版信息
J Am Med Dir Assoc. 2022 Nov;23(11):1868.e9-1868.e16. doi: 10.1016/j.jamda.2022.03.020. Epub 2022 May 13.
OBJECTIVE
To determine the effect of geriatric comanagement on clinical outcomes of older patients undergoing surgery for gastrointestinal cancer.
DESIGN
This was a single-center, nonrandomized, before-and-after study, which compared patient outcomes before and after the implementation of geriatric comanagement in an oncological surgery division.
SETTING AND PARTICIPANTS
The study included patients aged 70 or older, who were treated for a gastrointestinal cancer at the Oncological Surgery Division of the Policlinico San Martino Hospital (Genoa, Italy). Patients from the control group were treated between January 2015 and October 2018, and the patients who received geriatric comanagement during their stay in the surgical ward were treated between November 2018 and December 2019.
METHODS
Patients from both groups received a preoperative comprehensive geriatric assessment in the preoperative phase and were followed according to the Enhanced Recovery After Surgery model in the perioperative period. In the geriatric comanagement group, targeted interventions during daily geriatrician-led ward rounds were performed. Inverse probability weighting was used to adjust estimates for potential baseline confounders.
RESULTS
A total of 207 patients were included: 107 in the control group and 90 who received geriatric comanagement. Overall, patients from both groups had similar demographic and clinical characteristics with a median [interquartile range (IQR)] age of 80.0 (77.0, 84.0) years and a pre-frail phenotype [median (IQR) 40-item Frailty Index 0.15 (0.10, 0.26)]. In the geriatric comanagement group, a significant reduction in grade I-V complications (adjusted odds ratio 0.29; 95% CI 0.21-0.40); P < .001) and in 1-year readmissions (adjusted hazard ratio 0.53; 95% CI 0.28-0.98; P < .044) was observed. No difference between the 2 groups in terms of 1-year mortality was detected.
CONCLUSIONS AND IMPLICATIONS
Our study supports the implementation of geriatric comanagement in the care of older patients undergoing surgery for gastrointestinal cancer.
目的
确定老年共管理对接受胃肠癌手术的老年患者临床结局的影响。
设计
这是一项单中心、非随机、前后对照研究，比较了胃肠癌外科病房实施老年共管理前后患者的结局。
地点和参与者
本研究纳入了意大利热那亚 Policlinico San Martino 医院肿瘤科外科部年龄 70 岁或以上的胃肠癌患者。对照组患者于 2015 年 1 月至 2018 年 10 月接受治疗，而在外科病房住院期间接受老年共管理的患者于 2018 年 11 月至 2019 年 12 月接受治疗。
方法
两组患者在术前阶段均接受全面的老年综合评估，并在围手术期根据加速康复外科模型进行随访。在老年共管理组中，由老年医生在日常查房时进行有针对性的干预。采用逆概率加权法调整潜在基线混杂因素的估计值。
结果
共纳入 207 例患者：对照组 107 例，老年共管理组 90 例。两组患者总体上具有相似的人口统计学和临床特征，中位（四分位距）年龄为 80.0（77.0，84.0）岁，衰弱前期表型[40 项衰弱指数中位数（四分位距）0.15（0.10，0.26）]。在老年共管理组，I-V 级并发症发生率显著降低（调整后比值比 0.29；95%CI 0.21-0.40；P <.001），1 年再入院率也显著降低（调整后风险比 0.53；95%CI 0.28-0.98；P <.044）。两组患者 1 年死亡率无差异。
结论和意义
本研究支持在胃肠癌手术老年患者的治疗中实施老年共管理。
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