Preoperative geriatric assessment: Comprehensive, multidisciplinary and proactive

Dewan, Sheilesh Kumar; Zheng, Song; Xia, Shi Jin

doi:10.1016/j.ejim.2012.06.009

Cited by 31 publications

(15 citation statements)

References 74 publications

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“…In conclusion, the interrelation between comorbidity, complication rate and 90-day mortality underlines the need for a comprehensive geriatric assessment of elderly patients with MIBC prior to cystectomy [28]. Chronological age per se should not preclude any elderly/geriatric patient from RC.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Complications and 90-Day Mortality of Radical Cystectomy in the Elderly (75+): A Retrospective, Multicentre Study

Berger¹,

Martini

Wehrberger

et al. 2014

Urol Int

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Objective: To assess perioperative complications and 90-day mortality of radical cystectomy (RC) in elderly patients with muscle-invasive bladder cancer (MIBC). Materials and Methods: This is a retrospective, multicentre (n = 11) study of a consecutive series of patients ≥75 years who underwent RC for MIBC between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification. Results: A total of 256 patients with a mean age of 79.6 years (range 75.0-86.6) were analysed. Urinary diversion with the use of bowel was performed in 79.5% and ureterocutaneostomy in 20.5%, with a higher proportion in the ≥80 cohort (32.2 vs. 14%; p = 0.001). 41.4% of patients had an uneventful postoperative course (Clavien grade 0) and 26.6% developed severe complications (Clavien grade III-V). In a multivariable regression analysis, the Charlson comorbidity index (odds ratio 1.5 per unit increase; p < 0.001) and the body mass index (odds ratio 1.13 per kg/m² increase; p = 0.015) were predictors for the development of complications. The 90-day mortality rate was 9% and the independent correlates thereof were the development of severe medical complications (p = 0.004), the American Society of Anesthesiologists (ASA) score (p = 0.03) and age (p = 0.005). Conclusions: Morbidity and 90-day mortality of RC in the elderly remain substantial. The interrelation between comorbidity, complication rate and 90-day mortality underlines the need for a comprehensive geriatric assessment of elderly patients with MIBC in whom RC is indicated.

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Section: Discussionmentioning

confidence: 99%

Perioperative Complications and 90-Day Mortality of Radical Cystectomy in the Elderly (75+): A Retrospective, Multicentre Study

Berger¹,

Martini

Wehrberger

et al. 2014

Urol Int

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“…40 Finally, a recent review remarked that available preoperative geriatric risk assessment tools based on CGA could offer a basis to improve peri-operative outcome. 5 The limitation of the study is clearly related to the exclusion of elderly patients with indication for emergency surgery representing patients with the worst prognosis. 41 Our elderly patients with an indication for surgery were functionally fit, which probably significantly influences the low mortality and morbidity observed.…”

Section: Discussionmentioning

confidence: 99%

“…2 Therefore, the assessment of surgical risk in elderly patients should assume progressively greater importance. [3][4][5][6] The 30-day mortality in patients older than 80 years enrolled in the "Veterans Affairs National Surgical Quality Improvement Project" (NSQIP) underwent non-cardiac surgery, both elective and in emergency. 7 In this sample, the mortality was 8% and reached 25% in elderly patients who experienced major complications; peak mortalities was52% for acute renal failure and 88% for myocardial infarction.…”

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confidence: 99%

Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study

Abete

Cherubini

Bari

et al. 2016

The American Journal of Surgery

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“…Older adults have surgery four times more often than the rest of the population, making care for elderly surgical patients of prime importance [2]. Recent studies have attempted to characterize elderly patients preoperatively to predict surgical outcomes [2–9]. However, there is still a need to identify preoperative measures that are not only effective but are also efficient and practical to implement.…”

Section: Introductionmentioning

confidence: 99%

Preoperative impairment is associated with a higher postdischarge level of care

Ehlenbach

Tevis

Kennedy

et al. 2015

Journal of Surgical Research

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Background Although preoperative risk factors have been shown to lead to postdischarge institutionalization, an association between preoperative risk factors, preoperative level of required care, and discharge to higher levels of care has not previously been demonstrated. Materials and methods Using an institutional American College of Surgeons National Surgical Quality Improvement Program database, a retrospective review of elderly patients undergoing nonemergent inpatient general surgery procedures was performed with the goal of identifying preoperative risk factors that indicated the need for a higher level of care on hospital discharge. Univariate and multivariate analyses were performed on the patient population. Results Over a 4-y period, 585 patients (29%) within the database were aged ≥65 y. In this population, 12% of patients required discharge to a higher level of care compared with their preoperative origin. In patients aged ≥65 y, impaired cognition, decreased functional capacity, advanced age (≥79 y), high American Society of Anesthesiologists class, and long hospital length of stay were found in univariate analysis to be associated with postoperative discharge to a higher level of care, although all of these variables except decreased functional capacity were also associated with a higher discharge level of care in multivariate analysis. Conclusions Cognitive and functional capacity scoring can be used as simple ways to indicate discharge to a higher level of care for older adults. Preoperative counseling in high-risk older adults needs to include the likelihood for discharge to a higher level of care, so that a possible referral to social work can be placed during discharge planning.

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Preoperative geriatric assessment: Comprehensive, multidisciplinary and proactive

Cited by 31 publications

References 74 publications

Perioperative Complications and 90-Day Mortality of Radical Cystectomy in the Elderly (75+): A Retrospective, Multicentre Study

Perioperative Complications and 90-Day Mortality of Radical Cystectomy in the Elderly (75+): A Retrospective, Multicentre Study

Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study

Preoperative impairment is associated with a higher postdischarge level of care

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