Functional impairment prior to major non-cardiac surgery is associated with mortality within one year in elderly patients with gastrointestinal, gynaecological and urogenital cancer: A prospective observational cohort study

Schmidt, Maren; Eckardt, Rahel; Altmeppen, Sarah; Wernecke, Klaus‐Dieter; Spies, Claudia

doi:10.1016/j.jgo.2017.07.011

Cited by 29 publications

(31 citation statements)

References 33 publications

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“…In a 2018 prospective cohort study among 131 patients ≥ 65 years old who underwent elective major surgery for cancer, those who were dependent in ADLs and had an unfavorable TUG test had a significantly higher 1-year mortality (odds ratio [OR] 4.5, 95% CI 1.21-18.25, P = 0.034) than the other patients. As such, functional assessments such as ADL and TUG test as well as mild cognitive impairment are predictors of long-term outcomes in elderly cancer patients [11]. A 2005 prospective study of 120 patients ≥ 60 years old who underwent thoracic surgery also showed dependence in ADLs and impaired cognitive conditions as important predictors of postoperative complications [12].…”

Section: Assessment Of Functional Reservementioning

confidence: 99%

Anesthetic management of geriatric patients

Lim

2020

Korean J Anesthesiol

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The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

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Section: Assessment Of Functional Reservementioning

confidence: 99%

Anesthetic management of geriatric patients

Lim

2020

Korean J Anesthesiol

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“…A gait speed of less than 0.8 m/s indicates slowness, and is predictive of poor clinical outcomes such as disability, falls and institutionalization (27). Functional dependency, a geriatric syndrome where a person is not able to live independently and complete basic activities of daily living (ADLs), is a predictor of postoperative complications and increased mortality (4,8,16). In addition, a dependent patient requires careful discharge planning starting from the time of admission.…”

Section: Assess Life Expectancy Without Cancerfrailty Comorbidity Amentioning

confidence: 99%

“…Elective surgery is generally safe when considering perioperative mortality, which is less than 4%, even in older patients(1). Post-operative morbidity, however, is high in frail patients, usually exceeding 50% when complications are assessed prospectively (2)(3)(4). In treating older patients with colorectal cancer, surgeons should take note of two critical points: (1) to look beyond chronological age when evaluating the risk associated with colorectal surgery and (2) to be able to uncover frailty in the individual patient.…”

Section: Introductionmentioning

confidence: 99%

Basic geriatric principles for colorectal surgeons: How to optimize assessment and care of older patients in the perioperative period

Rostoft

Hamaker

2020

European Journal of Surgical Oncology

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Background: The majority of patients with colorectal cancer are older. For surgeons dealing with older patients, it is important to recognize patients that are frail and have an increased risk of complications and mortality. In this review, we will go through pre-treatment assessment, peri-operative management, as well as discharge planning and rehabilitation. Methods: This review is based on searching the literature for studies regarding colorectal cancer, frailty, cognition, patient preferences and geriatric assessment as well as the academic and clinical experience of the authors. Results: In the pre-treatment assessment, surgeons need to consider capacity to consent, patient preferences, frailty and life-expectancy, risk of complications, and whether the patient can be optimized before surgery. Then, the patient and treatment options should be discussed at a multidisciplinary team meeting. When the patient is admitted for surgery, discharge planning should start immediately, and if complications such as delirium or falls occur, the patient should be co-managed with geriatric services. Conclusion: Frail older adults with colorectal cancer need a tailored approach from pre-treatment assessment until discharge after surgery, and co-management with a geriatrician is recommended. If this is not possible, surgeons treating frail older patients may improve care by adapting some geriatric principles.

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“…A preoperative evaluation of functional capacity is also needed to estimate the patient's ability for coping with surgical stress, as functional impairment has been linked to higher 1-year mortality in elderly gastrointestinal cancer patients [36]. Metabolic equivalents (MET) are used to quantify functional capacity, whereas 1 MET reflects the metabolic rate at rest and >10 METs depict the metabolic rate during exertive sports.…”

Section: Cardiovascular Riskmentioning

confidence: 99%

Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia

et al. 2017

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Introduction: Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. Methods: We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities. Results: Especially in combination with advanced age, the effects of malignancies can be devastating, bringing new health challenges, exacerbating preexisting conditions, and exerting severe psychological strain. An interdisciplinary assessment and process planning provide an ideal setting to identify and prevent potential complications, especially in regards to frailty and cardiovascular risk. In addition, important perioperative considerations are presented, such as malnutrition, fasting, intraoperative neuromonitoring, and hemodynamic control, as well as postoperative early mobilization, pain, and delirium management. Conclusion: The decisions and interventions made in the perioperative stage can positively influence many intra- and postoperative factors, significantly improving the chances of successful treatment of elderly cancer patients. Appropriate management can help prevent or mitigate complications, secure a quick recovery, and improve short- and long-term outcomes.

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Functional impairment prior to major non-cardiac surgery is associated with mortality within one year in elderly patients with gastrointestinal, gynaecological and urogenital cancer: A prospective observational cohort study

Abstract: German Clinical Trials Register (DRKS 00005150).

Cited by 29 publications

References 33 publications

Anesthetic management of geriatric patients

Anesthetic management of geriatric patients

Basic geriatric principles for colorectal surgeons: How to optimize assessment and care of older patients in the perioperative period

Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia

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