Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands; University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands.
Department of Surgery, Reinier de Graaff Hospital, Leiden, the Netherlands.
J Geriatr Oncol. 2022 Jul;13(6):796-802. doi: 10.1016/j.jgo.2022.05.004. Epub 2022 May 20.
Older patients have a higher risk for complications after rectal cancer surgery. Although screening for geriatric impairments may improve risk prediction in this group, it has not been studied previously.
We retrospectively investigated patients ≥70 years with elective surgery for non-metastatic rectal cancer between 2014 and 2018 in nine Dutch hospitals. The predictive value of six geriatric parameters in combination with standard preoperative predictors was studied for postoperative complications, delirium, and length of stay (LOS) using logistic regression analyses. The geriatric parameters included the four VMS-questionnaire items pertaining to functional impairment, fall risk, delirium risk, and malnutrition, as well as mobility problems and polypharmacy. Standard predictors included age, sex, body mass index, American Society of Anesthesiologists (ASA)-classification, comorbidities, tumor stage, and neoadjuvant therapy. Changes in model performance were evaluated by comparing Area Under the Curve (AUC) of the regression models with and without geriatric parameters.
We included 575 patients (median age 75 years; 32% female). None of the geriatric parameters improved risk prediction for complications or LOS. The addition of delirium risk to the standard preoperative prediction model improved model performance for predicting postoperative delirium (AUC 0.75 vs 0.65, p = 0.03).
Geriatric parameters did not improve risk prediction for postoperative complications or LOS in older patients with rectal cancer. Delirium risk screening using the VMS-questionnaire improved risk prediction for delirium. Older patients undergoing rectal cancer surgery are a pre-selected group with few impairments. Geriatric screening may have additional value earlier in the care pathway before treatment decisions are made.
老年患者在接受直肠癌手术后发生并发症的风险更高。虽然筛查老年患者的功能障碍可能会改善该人群的风险预测，但此前尚未对此进行研究。
我们回顾性调查了 2014 年至 2018 年期间在 9 家荷兰医院接受择期非转移性直肠癌手术的年龄≥70 岁的患者。使用逻辑回归分析研究了 6 项老年参数与标准术前预测因子相结合对术后并发症、谵妄和住院时间（LOS）的预测价值。老年参数包括与功能障碍、跌倒风险、谵妄风险和营养不良以及活动能力问题和多药合用相关的 4 个 VMS 问卷项目，以及标准预测因子，包括年龄、性别、体重指数、美国麻醉医师协会（ASA）分级、合并症、肿瘤分期和新辅助治疗。通过比较有和无老年参数的回归模型的曲线下面积（AUC）来评估模型性能的变化。
我们纳入了 575 名患者（中位年龄 75 岁；32%为女性）。老年参数均不能改善并发症或 LOS 的风险预测。将谵妄风险添加到标准术前预测模型中，改善了术后谵妄的风险预测（AUC 0.75 比 0.65，p=0.03）。
老年参数不能改善老年直肠癌患者术后并发症或 LOS 的风险预测。使用 VMS 问卷进行谵妄风险筛查可改善谵妄的风险预测。接受直肠癌手术的老年患者是经过预先选择的，功能障碍较少。老年患者在做出治疗决策之前，在治疗决策之前的护理路径中可能会有更多的老年筛查价值。
