Department of Colon and Rectal Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Health Services Research, the University of Texas, MD Anderson Cancer Center, Houston, TX.
Ann Surg. 2024 Oct 1;280(4):623-632. doi: 10.1097/SLA.0000000000006458. Epub 2024 Jul 29.
To assess the effect of a practice-level preoperative frailty screening and optimization toolkit (OPTI-Surg) on postoperative functional recovery and complications in elderly cancer patients undergoing major surgery.
Frailty is common in older adults. It increases the risk of poor postoperative functional recovery and complications. The potential for a practice-level screening/optimization intervention to improve outcomes is unknown.
Thoracic, gastrointestinal, and urologic oncological surgery practices within the National Cancer Institute Community Oncology Research Program (NCORP) were randomized 1:1:1 to usual care (UC), OPTI-Surg, or OPTI-Surg with an implementation coach. OPTI-Surg consisted of the Edmonton Frail Scale and guided recommendations for referral interventions. Patients 70 years old or above undergoing curative intent surgery were eligible. The primary outcome was 8 weeks postoperative function (kcal/wk). The key secondary outcome was complications within 90 days. Mixed models were used to compare UC to the 2 OPTI-Surg arms combined.
From July 2019 to September 2022, 325 patients were enrolled in 29 practices. One hundred ninety-nine (64 UC, 135 OPTI-Surg) and 279 (78 UC, 201 OPTI-Surg) were evaluable for primary and secondary analysis, respectively. UC and OPTI-Surg patients did not significantly differ in total caloric expenditure (2.2 UC, 2.0 OPTI-Surg) after adjusting for baseline function ( P =0.53). UC and OPTI-Surg patients did not significantly differ in postoperative complications (25.6% UC, 35.3% OPTI-Surg, P =0.5).
Frailty assessment was successfully performed, but the OPTI-Surg intervention did not improve postoperative function nor reduce postoperative complications compared with UC. Future analysis will explore practice-level factors associated with toolkit implementation and the differences between the coaching and noncoaching arms.
评估基于实践的术前衰弱筛查和优化工具包（OPTI-Surg）对接受大型手术的老年癌症患者术后功能恢复和并发症的影响。
衰弱在老年人中很常见。它增加了术后功能恢复不良和并发症的风险。基于实践的筛查/优化干预改善结局的潜力尚不清楚。
国家癌症研究所社区肿瘤学研究计划（NCORP）内的胸科、胃肠科和泌尿科肿瘤学实践按 1:1:1 的比例随机分为常规护理（UC）、OPTI-Surg 或接受实施教练指导的 OPTI-Surg。OPTI-Surg 包括埃德蒙顿衰弱量表和转诊干预的指导建议。接受根治性手术的 70 岁或以上的患者符合条件。主要结局是术后 8 周的功能（kcal/wk）。关键次要结局是 90 天内的并发症。混合模型用于比较 UC 与 2 个 OPTI-Surg 手臂的总和。
从 2019 年 7 月到 2022 年 9 月，在 29 个实践中纳入了 325 名患者。199 名（64 名 UC，135 名 OPTI-Surg）和 279 名（78 名 UC，201 名 OPTI-Surg）分别可用于主要和次要分析。调整基线功能后，UC 和 OPTI-Surg 患者的总热量消耗（2.2 UC，2.0 OPTI-Surg）没有显著差异（P=0.53）。UC 和 OPTI-Surg 患者的术后并发症（25.6% UC，35.3% OPTI-Surg，P=0.5）没有显著差异。
衰弱评估成功进行，但与 UC 相比，OPTI-Surg 干预并未改善术后功能或减少术后并发症。未来的分析将探讨与工具包实施相关的实践水平因素以及辅导和非辅导手臂之间的差异。
