Skip to main content

Advertisement

SpringerLink
Log in

Does Preoperative Comprehensive Geriatric Assessment and Frailty Predict Postoperative Complications?

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The influence of preoperative comprehensive geriatric assessment and frailty on postoperative morbidity, mortality, delirium were examined.

Methods

A total of 108 patients were evaluated. The Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Brody Instrumental Activities of Daily Living Scale (IADL), the Mini-Nutrition Assessment test (MNA), the Mini-Mental State Examination (MMSE), Yesavage Geriatric Depression Scale (GDS) were performed. Fried Criteria were used to assess physical frailty. We used the Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity score (POSSUM), the American Society of Anesthesiologists Score (ASA), and the Charlson Comorbidity Index (CCI) to determine the risk of postoperative morbidity and mortality. Assessment Test for Delirium (4AT) was applied for detection of delirium.

Results

The median age was 71 years (min–max: 65–84). IADL (p = 0.032), MNA (p = 0.01), MMSE scores (p = 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p = 0.005), operative score (p = 0.015) and CCI (p = 0.029) were significantly higher in the patients with morbidity. Patients developed morbidity were found to be more frail (p < 0.001). The patients with delirium were found to have lower IADL (p = 0.049) and MMSE scores (p = 0.004), higher POSSUM physiology score (p = 0.005) and all of them were frail. It was found that frailty (OR = 23.695 95% CI: 6.912–81.231 p < 0.001), POSSUM operative score (OR:1.118 95% CI: 1.021–1.224 p = 0.016) and preoperative systolic blood pressure (OR:0.937%95 CI: 0.879–0.999 p = 0.048) were independently related factors for postoperative morbidity.

Conclusion

In our study, CGA and frailty in preoperative period were found to be indicators for postoperative morbidity and delirium.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ghignone F, Van Leeuwen B, Montroni I et al (2016) The assessment and management of older cancer patients: a SIOG surgical task force survey on surgeons' attitudes. Eur J Surg Oncol (EJSO) 42:297–302

    CAS  Google Scholar 

  2. Mokutani Y, Mizushima T, Yamasaki M et al (2016) Prediction of postoperative complications following elective surgery in elderly patients with colorectal cancer using the comprehensive geriatric assessment. Dig Surg 33:470–477

    PubMed  Google Scholar 

  3. Kenig J, Wałęga P, Olszewska U et al (2016) Geriatric assessment as a qualification element for elective and emergency cholecystectomy in older patients. World J Emerg Surg 11:36

    PubMed  PubMed Central  Google Scholar 

  4. Knittel JG, Wildes TS (2016) Preoperative assessment of geriatric patients. Anesthesiol Clin 34:171–183

    PubMed  Google Scholar 

  5. Stuck AE, Siu AL, Wieland GD et al (1993) Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342:1032–1036

    CAS  PubMed  Google Scholar 

  6. Feng MA, McMillan DT, Crowell K et al (2015) Geriatric assessment in surgical oncology: a systematic review. J Surg Res 193:265–272

    PubMed  Google Scholar 

  7. Wildiers H, Heeren P, Puts M et al (2014) International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32:2595

    PubMed  PubMed Central  Google Scholar 

  8. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol Ser A: Biol Sci Med Sci 56:M146–M157

    CAS  Google Scholar 

  9. Robinson TN, Walston JD, Brummel NE et al (2015) Frailty for Surgeons: Review of a National Institute on Aging Conference on Frailty for Specialists. J Am Coll Surg 221:1083–1092

    PubMed  PubMed Central  Google Scholar 

  10. Joseph B, Zangbar B, Pandit V et al (2016) Emergency general surgery in the elderly: too old or too frail? J Am Coll Surg 222:805–813

    PubMed  Google Scholar 

  11. Kim S-w, Han H-S, Jung H-w et al (2014) Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg 149:633–640

    PubMed  Google Scholar 

  12. Cooper Z, Rogers SO Jr, Ngo L et al (2016) Comparison of frailty measures as predictors of outcomes after orthopedic surgery. J Am Geriatr Soc 64:2464–2471

    PubMed  PubMed Central  Google Scholar 

  13. Chow WB, Rosenthal RA, Merkow RP et al (2012) Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 215:453–466

    PubMed  Google Scholar 

  14. Monk TG, Weldon BC, Garvan CW et al (2008) Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 108:18–30

    PubMed  Google Scholar 

  15. Stenvall M, Berggren M, Lundström M et al (2012) A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia—subgroup analyses of a randomized controlled trial. Arch Gerontol Geriatr 54:e284–e289

    PubMed  Google Scholar 

  16. Chen CC-H, Li H-C, Liang J-T et al (2017) Effect of a modified hospital elder life program on delirium and length of hospital stay in patients undergoing abdominal surgery: a cluster randomized clinical trial. JAMA Surg 152:827–834

    PubMed  PubMed Central  Google Scholar 

  17. Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged. the index of adl: a standardized measure of biological and psychosocial function. JAMA 185:914–919

    CAS  PubMed  Google Scholar 

  18. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    CAS  PubMed  Google Scholar 

  19. Arik G, Varan HD, Yavuz BB et al (2015) Validation of Katz index of independence in activities of daily living in Turkish older adults. Arch Gerontol Geriatr 61:344–350

    PubMed  Google Scholar 

  20. Folstein MF, Folstein SE, McHugh PR (1975) "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    CAS  Google Scholar 

  21. Güngen C, Ertan T, Eker E et al (2002) Standardize mini mental test’in Türk toplumunda hafif demans tan› s› nda geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi 13:273–281

    PubMed  Google Scholar 

  22. Stahelin HB, Monsch AU, Spiegel R (1997) Early diagnosis of dementia via a two-step screening and diagnostic procedure. Int Psychogeriatr 9(Suppl 1):123–130

    PubMed  Google Scholar 

  23. Yesavage JA (1988) Geriatric depression scale. Psychopharmacol Bull 24:709–711

    CAS  PubMed  Google Scholar 

  24. Rubenstein LZ, Harker JO, Salva A et al (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 56:M366–372

    CAS  Google Scholar 

  25. Sarikaya D, Halil M, Kuyumcu ME et al (2015) Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 61:56–60

    PubMed  Google Scholar 

  26. Copeland G, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:355–360

    CAS  PubMed  Google Scholar 

  27. Saklad M (1941) Grading of patients for surgical procedures. Anesthesiol J Am Soc Anesthesiol 2:281–284

    Google Scholar 

  28. Abete P, Cherubini A, Di Bari M et al (2016) Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study. Am J Surg 211(76–83):e72

    Google Scholar 

  29. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    CAS  Google Scholar 

  30. Bellelli G, Morandi A, Davis DH et al (2014) Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing 43:496–502

    PubMed  PubMed Central  Google Scholar 

  31. Tominaga T, Takeshita H, Takagi K et al (2016) E-PASS score as a useful predictor of postoperative complications and mortality after colorectal surgery in elderly patients. Int J Colorectal Dis 31:217–225

    PubMed  Google Scholar 

  32. Lee YH, Oh H-K, Kim D-W et al (2016) Use of a comprehensive geriatric assessment to predict short-term postoperative outcome in elderly patients with colorectal cancer. Ann Coloproctol 32:161

    PubMed  PubMed Central  Google Scholar 

  33. Audisio RA, Pope D, Ramesh HSJ et al (2008) Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help: A SIOG surgical task force prospective study. Crit Rev Oncol Hematol 65:156–163

    CAS  PubMed  Google Scholar 

  34. Fagard K, Casaer J, Wolthuis A et al (2017) Value of geriatric screening and assessment in predicting postoperative complications in patients older than 70 years undergoing surgery for colorectal cancer. J Geriatr Oncol 8:320–327

    PubMed  Google Scholar 

  35. Kenig J, Olszewska U, Zychiewicz B et al (2015) Cumulative deficit model of geriatric assessment to predict the postoperative outcomes of older patients with solid abdominal cancer. J Geriatr Oncol 6:370–379

    PubMed  Google Scholar 

  36. Kristjansson SR, Jordhøy MS, Nesbakken A et al (2010) Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery? J Geriatr Oncol 1:57–65

    Google Scholar 

  37. Hodari A, Hammoud ZT, Borgi JF et al (2013) Assessment of morbidity and mortality after esophagectomy using a modified frailty index. Ann Thorac Surg 96:1240–1245

    PubMed  Google Scholar 

  38. Obeid NM, Azuh O, Reddy S et al (2012) Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program: exploring frailty and aggressive laparoscopic approaches. J Trauma Acute Care Surg 72:878–883

    PubMed  Google Scholar 

  39. Makary MA, Segev DL, Pronovost PJ et al (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210:901–908

    PubMed  Google Scholar 

  40. Seib CD, Rochefort H, Chomsky-Higgins K et al (2018) Association of patient frailty with increased morbidity after common ambulatory general surgery operations. JAMA Surg 153:160–168

    PubMed  Google Scholar 

  41. Partridge J, Harari D, Martin F et al (2014) The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review. Anaesthesia 69:8–16

    PubMed  Google Scholar 

  42. Turrentine FE, Wang H, Simpson VB et al (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203:865–877

    PubMed  Google Scholar 

  43. Tan K, Kawamura Y, Mizokami K et al (2009) Colorectal surgery in octogenarian patients—outcomes and predictors of morbidity. Int J Colorectal Dis 24:185–189

    CAS  PubMed  Google Scholar 

  44. Gomes A, Rocha R, Marinho R et al (2015) Colorectal surgical mortality and morbidity in elderly patients: comparison of POSSUM, P-POSSUM, CR-POSSUM, and CR-BHOM. Int J Colorectal Dis 30:173–179

    PubMed  Google Scholar 

  45. Koo CY, Hyder JA, Wanderer JP et al (2015) A meta-analysis of the predictive accuracy of postoperative mortality using the American Society of Anesthesiologists’ physical status classification system. World J Surg 39:88–103. https://doi.org/10.1007/s00268-014-2783-9

    PubMed  Google Scholar 

  46. Caillet P, Laurent M, Bastuji-Garin S et al (2014) Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment. Clin Interv Aging 9:1645

    PubMed  PubMed Central  Google Scholar 

  47. Raats JW, van Eijsden WA, Crolla RM et al (2015) Risk factors and outcomes for postoperative delirium after major surgery in elderly patients. PLoS ONE 10:e0136071

    PubMed  PubMed Central  Google Scholar 

  48. Jeong YM, Lee E, Kim K-I et al (2016) Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment. BMC Geriatr 16:134

    PubMed  PubMed Central  Google Scholar 

  49. Watt J, Tricco AC, Talbot-Hamon C et al (2018) Identifying older adults at risk of delirium following elective surgery: a systematic review and meta-analysis. J Gen Intern Med 33:500–509

    PubMed  PubMed Central  Google Scholar 

  50. Barr J, Fraser GL, Puntillo K et al (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41:263–306

    PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey

    Rana Tuna Dogrul, Fatih Sumer, Hatice Caliskan, Muhammet Cemal Kizilarslanoglu, Mustafa Kemal Kilic, Cafer Balci, Gunes Arik, Gozde Sengul Aycicek, Cemile Ozsurekci, Meltem Halil, Mustafa Cankurtaran & Burcu Balam Yavuz

  2. Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Ahmet Bulent Dogrul & Ali Konan

  3. Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Omur Caglar

Authors
  1. Rana Tuna Dogrul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmet Bulent Dogrul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali Konan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Omur Caglar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fatih Sumer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hatice Caliskan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Muhammet Cemal Kizilarslanoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mustafa Kemal Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Cafer Balci
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gunes Arik
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Gozde Sengul Aycicek
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Cemile Ozsurekci
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Meltem Halil
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Mustafa Cankurtaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Burcu Balam Yavuz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rana Tuna Dogrul.

Ethics declarations

Conflict of interest

The Authors' declares that they have no conflict of interest.

Informed consent

Informed consent was obtained from all participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dogrul, R.T., Dogrul, A.B., Konan, A. et al. Does Preoperative Comprehensive Geriatric Assessment and Frailty Predict Postoperative Complications?. World J Surg 44, 3729–3736 (2020). https://doi.org/10.1007/s00268-020-05715-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05715-8

Search

Navigation