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Ann Surg Oncol. 2019 Jan;26(1):71-78. doi: 10.1245/s10434-018-6867-x. Epub 2018 Oct 25.

The Prognostic Value of a Geriatric Risk Score for Older Patients with Colorectal Cancer.

Author information

1
Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands. e.souwer@hagaziekenhuis.nl.
2
Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.
3
Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
4
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
5
Department of Geriatrics, Diakonessenhuis, Utrecht, The Netherlands.
6
Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
7
Department of Geriatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands.
8
Department of Surgery, Haga Hospital, The Hague, The Netherlands.
9
Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands.
10
Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

INTRODUCTION:

VMS is a Dutch risk assessment tool for hospitalized older adults that includes a short evaluation of four geriatric domains: risk for delirium, risk for undernutrition, risk for physical impairments, and fall risk. We investigated whether the information derived from this tool has prognostic value for outcomes of colorectal surgery.

METHODS:

All consecutive patients over age 70 years who underwent elective colorectal cancer surgery in three Dutch hospitals (2014-2016) were studied. The presence of risk was scored prior to surgery and per geriatric domain as either 0 (risk absent) or 1 (risk present). The total number of geriatric risk factors was summed. The primary outcome was long-term survival. Secondary outcomes were postoperative complications, including delirium. Cox proportional hazards models were used to evaluate the sumscore and risk factors associated with overall survival.

RESULTS:

Five hundred fifty patients were included. Median age was 76.5 years, and median follow-up was 870 days. Patients with intermediate (1-2) or high (3-4) sumscore were independently associated with lower overall survival, with hazard ratio (HR) of 1.9 [95% confidence interval (CI) 1.1-3.5; p = 0.03] and 8.7 (95% CI 4.0-19.2; p < 0.001), respectively. Sumscores were also associated with postoperative complications (intermediate sumscore OR 1.8; 95% CI 1.2-2.7; high sumscore OR 2.4; 95% CI 1.02-5.5).

CONCLUSIONS:

This easy-to-use geriatric sumscore has strong associations with long-term outcome and morbidity after colorectal cancer surgery. This information may be included in risk models for morbidity and mortality and can be used in shared decision-making.

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