New Onset Geriatric Syndromes and One-year Outcomes Following Elective Gastrointestinal Cancer Surgery

Abstract

Objective: To assess whether older adults who develop geriatric syndromes following elective gastrointestinal surgery have poorer 1-year outcomes. Summary Background Data: Within ten years, 70% of all cancers will occur in older adults ≥65 years old. The rise in older adults requiring major surgery has brought attention to age-related complications termed geriatric syndromes. However, whether postoperative geriatric syndromes are associated with long-term outcomes is unclear. Methods: A population-based retrospective cohort study using the New York State Cancer Registry and the Statewide Planning and Research Cooperative System was performed including patients >55 years with pathologic stage I-III esophageal, gastric, pancreatic, colon, or rectal cancer who underwent elective resection between 2004-2018. Those aged 55-64 served as the reference group. The exposure of interest was a geriatric syndrome (fracture, fall, delirium, pressure ulcer, depression, malnutrition, failure to thrive, dehydration, or incontinence [urinary/fecal]) during the surgical admission. Patients with any geriatric syndrome within 1 year of surgery were excluded. Outcomes included incident geriatric syndrome, 1-year days alive and out of the hospital, and 1-year all-cause mortality. Results: 37,998 patients with a median age of 71 years without a prior geriatric syndrome were included. Of those 65 years or more, 6.4% developed a geriatric syndrome. Factors associated with an incident geriatric syndrome were age, alcohol/tobacco use, comorbidities, neoadjuvant therapy, ostomies, open surgery, and upper gastrointestinal cancers. An incident geriatric syndrome was associated with a 43% higher risk of 1-year mortality (hazard ratio, 1.43; 95% confidence interval, 1.27-1.60). For those aged 65+ discharged alive and not to hospice, a geriatric syndrome was associated with significantly fewer days alive and out of hospital (322 vs. 346 d, P<0.0001). There was an indirect relationship between the number of geriatric syndromes and 1-year mortality and days alive and out of the hospital after adjusting for surgical complications. Conclusions: Given the increase in older adults requiring major surgical intervention, and the establishment of geriatric surgery accreditation programs, these data suggest that morbidity and mortality metrics should be adjusted to accommodate the independent relationship between geriatric syndromes and long-term outcomes.

Surgery Adherence and Survival Outcomes in Patients With Locally Advanced (IIA-IVA) Cancer of the Lower Esophagus: A SEER Database-Based Study

“…11 Age is one of the major risk factors for the development of atrial fibrillation in patients undergoing esophagectomy, according to a study by He et al 12 Another study revealed a substantial rise in the occurrence of postoperative bedsores, depression, confusion, and malnutrition in elderly patients who underwent gastrointestinal surgery. 13 Consequently, when confronted with heightened surgical threats and complications, elderly patients usually opt for more cautious treatment options. The results of our analysis show that female patients with esophageal cancer have poorer adherence to surgery than males, which may be one of the reasons for the current gradual decline in mortality rates for male patients with esophageal cancer and the slight increase in mortality rates for female patients with esophageal cancer in some European countries.…”