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Pre-surgical Geriatric Syndromes, Frailty, and Risks for Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: Prevalence and Red Flags

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Objective

We sought to identify and evaluate red flags for pre-surgical geriatric conditions (geriatric syndromes, frailty, and risks for postoperative delirium) in older patients undergoing gastrointestinal surgery.

Methods

Older individuals (≥65 years) undergoing major elective gastrointestinal surgery from 2009 to 2012 were enrolled and assessed preoperatively.

Results

Participants (N = 379; mean age = 74.5 ± 5.9 years) primarily underwent colorectal (54.3 %), gastric (21.9 %), and pancreatobiliary (12.6 %) surgery. Overall, 30.9 % had existing geriatric syndromes, 26.7 % were frail, and 22.8 % had >3 risk factors for postoperative delirium. The largest proportion (45.7 %) presented with at least one geriatric condition. Patients with or without geriatric conditions were discriminated with adequate sensitivity (67 %), specificity (84 %), and positive predictive value (77 %) by eight red flags: age ≥75 years (OR, 2.86; P < 0.001), eating soft food (OR, 3.63; P = 0.001), reported hypertension (OR, 2.8; P = 0.001), weight loss >3 kg (OR, 4.79; P < 0.001), fair-to-weak grip strength (OR, 2.53; P = 0.001), sleeplessness (OR, 2.57; P = 0.001), no-better-than-peer perceived health (OR, 1.88; P = 0.022), and short-term inability to recall two of three common words (OR, 1.81; P = 0.025).

Conclusions

Eight red flags covered as part of history and physical examination are well suited to screen patients for geriatric conditions indicating the need for preoperative geriatric assessments and optimization.

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Acknowledgments

This study was supported by a career development grant from the National Health Research Institute (Grant #NHRI-EX-9820PC) in Taiwan.

Conflict of Interest

The authors declare no conflict of interest.

Authors’ Contributions

Study concept and design are by Cheryl Chia-Hui Chen, Min-Tsan Lin, Chung-Jen Yen, and Guan-Hua Huang. Acquisition of subjects and data are by Cheryl Chia-Hui Chen, Min-Tsan Lin, and Jin-Tung Liang. Analysis and interpretation of data are done by Cheryl Chia-Hui Chen, Chun-Min Chen, and Guan-Hua Huang. Drafting or revising manuscript for important intellectual content by Cheryl Chia-Hui Chen, Min-Tsan Lin, Jin-Tung Liang, Chun-Min Chen, and Guan-Hua Huang. Approval of final version to be published was done by Cheryl Chia-Hui Chen, Min-Tsan Lin, Jin-Tung Liang, Chung-Jen Yen, Chun-Min Chen, and Guan-Hua Huang.

Sponsor’s Role

None of the finding agencies had any role in the design, methods, subject recruitment, data collection, analysis, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Nursing, College of Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan

    Cheryl Chia-Hui Chen

  2. Department of Surgery, College of Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan

    Ming-Tsan Lin & Jin-Tung Liang

  3. Department of Health Care Management, University of Kang Ning, Tainan, Taiwan

    Chun-Min Chen

  4. Department of Internal Medicine, College of Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan

    Chung-Jen Yen

  5. Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan

    Guan-Hua Huang

  6. School of Nursing, National Taiwan University, 1, Jen-Ai Rd., Section 1, Taipei, 100, Taiwan

    Cheryl Chia-Hui Chen

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  1. Cheryl Chia-Hui Chen
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Correspondence to Cheryl Chia-Hui Chen.

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Chen, C.CH., Lin, MT., Liang, JT. et al. Pre-surgical Geriatric Syndromes, Frailty, and Risks for Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: Prevalence and Red Flags. J Gastrointest Surg 19, 927–934 (2015). https://doi.org/10.1007/s11605-015-2760-0

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  • DOI: https://doi.org/10.1007/s11605-015-2760-0

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