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Components of geriatric assessments predict thoracic surgery outcomes
Anai Kothari1, Sarah Phillips, Traci Bretl
1University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA. kothari@wisc.edu
The Journal of Surgical Research
|September 11, 2010
Summary
This study found that specific questions from geriatric screening tools can predict surgical risk, complications, and discharge needs in elderly patients undergoing thoracic surgery. Answering "yes" to certain questions indicates higher risk and longer hospital stays.
Area of Science:
- Geriatric Medicine
- Thoracic Surgery
- Surgical Oncology
Background:
- Objective quantification of surgical risk in geriatric patients is lacking.
- Validated screening tools for geriatric syndromes exist but are not integrated for surgical risk assessment.
- Thoracic neoplasms present unique surgical challenges in elderly populations.
Purpose of the Study:
- To determine if individual questions from validated geriatric screening tools can predict surgical risk in geriatric patients with thoracic neoplasms.
- To assess the predictive value of these questions for operative risk, length of stay, and discharge destination.
- To develop a rapid, abbreviated presurgical assessment tool.
Main Methods:
- Prospective study of patients aged 70 years and older undergoing thoracic surgery.
- Preoperative administration of validated screening tests: Geriatric Depression Scale (GDS), Nutrition Screening Initiative Nutritional Health Checklist (NSI NHC), Mini Mental Status Exam (MMSE), Brief Fatigue Inventory (BFI).
- Assessment of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).
Main Results:
- Dependency in IADL "shopping" predicted major complications and non-home discharge (P = 0.011, 0.003).
- Positive responses to NSI NHC questions 1, 9, and 10 correlated with longer mean length of stay (P = 0.039, 0.010, 0.031).
- GDS question 2 correlated with major complications (P = 0.037), and GDS question 12 predicted non-home discharge (P = 0.047).
Conclusions:
- Individual questions from validated geriatric screening tools can effectively estimate operative risk in elderly patients with thoracic malignancies.
- These questions aid in predicting length of stay and discharge destination.
- An abbreviated, rapid presurgical assessment is feasible for optimizing geriatric thoracic surgery care.
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