Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery
Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery
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DOI：
10.1002/jso.23369
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发表时间：
2013-09-01
影响因子：
2.5
通讯作者：
Cormier, Janice N.
中科院分区：
文献类型：
--
作者：
Badgwell, Brian;Stanley, Jordan;Cormier, Janice N.
背景：本前瞻性研究的目的是确定老年患者腹部癌症手术后不良结果或资源利用率增加的危险因素。方法：前瞻性记录 65 岁接受腹腔内肿瘤手术患者的基线临床和老年评估变量，包括功能状态、营养状况、合并症指数、精神状态、抑郁量表评分、疲劳量表和多药用药量表。结果变量包括发病率、死亡率、出院护理机构、住院时间延长和再入院。结果：在 111 名患者中，手术类型为结直肠癌，占 40%，肝胰胆管占 30%，胃/十二指肠占 14%。多变量分析中与出院到护理机构相关的变量包括体重减轻 10%（OR 6.52 [95% CI：1.43-29.76]，P=0.02）、ASA 评分 2（OR 5.08 [1.13-22.77]，P=0.03）和 ECOG 评分 2（OR 4.51 [1.03-19.71]， P=0.04）。与住院时间延长独立相关的变量包括体重减轻10%（OR 4.03 [1.13-14.43]，P = 0.03）、是否存在多种药物治疗（OR 2.45 [1.09-5.48]，P = 0.03）和远处疾病（OR 0.37 [0.15-0.91]，P = 0.03）。没有变量与发病率或再入院相关。结论：术前临床和老年评估工具可以帮助预测是否需要出院到护理机构或增加住院时间。未来的研究需要确定适合干预措施的患者，以减少医院和出院后的资源利用率。 J.外科医生。安科尔。 2013年； 108：182-186。 (c) 2013 年 Wiley 期刊公司。
Background: The purpose of this prospective study was to identify risk factors for adverse outcomes or increased resource utilization after abdominal cancer surgery in geriatric patients.Methods: Baseline clinical and geriatric assessment variables including functional status, nutritional status, comorbidity index, mental status, depression scale score, fatigue inventory scale, and polypharmacy scale were prospectively recorded for patients age 65 undergoing intra-abdominal oncologic surgery. Outcome variables included morbidity, mortality, discharge to nursing facility, prolonged hospital stay, and readmission.Results: Of 111 patients, surgery type was colorectal in 40%, hepatopancreatobiliary in 30%, and gastric/duodenal in 14%. Variables associated with discharge to a nursing facility on multivariate analysis included weight loss 10% (OR 6.52 [95% CI: 1.43-29.76], P=0.02), ASA score 2 (OR 5.08 [1.13-22.77], P=0.03), and ECOG score 2 (OR 4.51 [1.03-19.71], P=0.04). Variables independently associated with prolonged hospital stay included weight loss 10% (OR 4.03 [1.13-14.43], P=0.03), the presence of polypharmacy (OR 2.45 [1.09-5.48], P=0.03), and distant disease (OR 0.37 [0.15-0.91], P=0.03). No variables were associated with morbidity or readmission.Conclusions: Pre-operative clinical and geriatric assessment tools can help predict the need for discharge to a nursing facility or increased length of stay. Future studies will be required to identify patients suitable for interventions to decrease hospital and post-discharge resource utilization. J. Surg. Oncol. 2013; 108:182-186. (c) 2013 Wiley Periodicals, Inc.