Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study - 14/12/15
, Antonio Cherubini, M.D., Ph.D. b, Mauro Di Bari, M.D., Ph.D. c, Carlo Vigorito, M.D. a, Giorgio Viviani, M.D. e, Niccolò Marchionni, M.D. c, Daniele D'Ambrosio, M.D. a, Alessandro Golino, M.D., Ph.D. a, Rocco Serra, M.D. d, Elena Zampi, M.D. d, Ilaria Bracali, M.D. c, AnnaMaria Mello, M.D. c, Alessandra Vitelli, M.D. a, Giuseppe Rengo, M.D., Ph.D. f, Francesco Cacciatore, M.D., Ph.D. f, Franco Rengo, M.D. fAbstract |
Background |
The evaluation of surgical risk is crucial in elderly patients. At present, there is little evidence of the usefulness of comprehensive geriatric assessment (CGA) as a part of the overall assessment of surgical elderly patients.
Methods |
We verified whether CGA associated with established surgical risk assessment tools is able to improve the prediction of postoperative morbidity and mortality in 377 elderly patients undergoing elective surgery.
Results |
Overall mortality and morbidity were 2.4% and 19.9%, respectively. Multivariate analysis showed that impaired cognitive function (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.15 to 4.22; P < .02) and higher Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (OR, 1.11; 95% CI, 1.00 to 1.23; P < .04) are predictive of mortality. Higher comorbidity is predictive of morbidity (OR, 2.12; 95% CI, 1.06 to 4.22; P < .03) and higher American Society of Anesthesiologists (OR, 2.18; 95% CI, 1.31 to 3.63; P < .001) and National Confidential Enquiry into Patient Outcome of Death score (OR, 2.03; 95% CI, 1.03 to 4.00; P < .04).
Conclusions |
In elective surgical elderly patients, the morbidity and mortality are low. The use of CGA improves the identification of elderly patients at higher risk of adverse events, independent of the surgical prognostic indices.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The evaluation of surgical risk is particularly important in older patients, who have a higher risk of adverse events during and after surgery. |
• | Comprehensive geriatric assessment is considered as a part of the overall assessment of surgical older patients. |
• | Comprehensive geriatric assessment improves the identification of older patients at higher risk of adverse events, independent of the most used surgical prognostic indices. |
Keywords : Surgical risk, Elderly patient, Mortality, Morbidity, Comprehensive geriatric assessment
Plan
| “Surgical risk in geriatric patients” is funded by PRIN 2006 (Programmi di ricerca scientifica di rilevante interesse nazionale–Anno 2006—prot. 2006063321) of the Italian Minister of University and Research. |
|
| The authors declare no conflicts of interest. |
Vol 211 - N° 1
P. 76 - janvier 2016 Retour au numéro
Article précédent
- Pancreaticoduodenectomy hospital resource utilization in octogenarians
- Russell C. Langan, Chun-Chih Huang, Weisheng Renee Mao, Katherine Harris, Will Chapman, Charles Fehring, Kesha Oza, Patrick G. Jackson, Reena Jha, Nadim Haddad, John Carroll, Jane Hanna, Ann Parker, Waddah B. Al-Refaie, Lynt B. Johnson
- Multiple primary melanoma in the elderly
- Adam C. Krajewski, Donna R. Hart, Tina J. Hieken
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?