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Colorectal Dis. 2018 Jan;20(1):16-25. doi: 10.1111/codi.13785.

Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial.

Author information

1
Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway.
2
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
3
Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.
4
K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway.
5
Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway.
6
The Cancer Unit, Innlandet Hospital Trust, Hamar, Norway.
7
Department of Public Health and Nursing, NTNU, Norway.

Abstract

AIM:

Colorectal cancer (CRC) is prevalent in the older population, and surgery is the mainstay of curative treatment. A preoperative geriatric assessment (GA) can identify frail older patients at risk for developing postoperative complications. In this randomized controlled trial we wanted to investigate whether tailored interventions based on a preoperative GA could reduce the frequency of postoperative complications in frail patients operated on for CRC.

METHOD:

Patients > 65 years scheduled for elective CRC surgery and fulfilling predefined criteria for frailty were randomized to either a preoperative GA followed by a tailored intervention or care as usual. The primary end-point was Clavien-Dindo Grade II-V postoperative complications. Secondary end-points included complications of any grade, reoperation, length of stay, readmission and survival.

RESULTS:

One hundred and twenty-two patients with a mean age of 78.6 years were randomized. We found no statistically significant differences between the intervention group and the control group for Grade II-V complications (68% vs 75%, P = 0.43), reoperation (19% vs 11%, P = 0.24), length of stay (8 days in both groups), readmission (16% vs 6%, P = 0.12) or 30-day survival (4% vs 5%, P = 0.79). Grade I-V complications occurred in 76% of patients in the intervention group compared with 87% in the control group (P = 0.10). In secondary analyses adjusting for prespecified prognostic factors, there was a statistically significant difference in favour of the intervention for reducing the total number of Grade I-V complications (P = 0.05).

CONCLUSION:

A preoperative GA and tailored interventions did not reduce the rate of Grade II-V complications, reoperations, readmission or mortality in frail older patients electively operated on for CRC.

KEYWORDS:

Geriatric assessment; colorectal cancer; frail elderly; postoperative complications

PMID:
28649755
DOI:
10.1111/codi.13785

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