International Comparison of Geriatric-Associated Variables in Major Gastroenterological Surgery Between National...

Incidence of malignant disease in older patients has been increasing. These geriatric patients have more comorbidities and frailty than younger patients, necessitating different approaches in evaluation and treatment. Geriatric surgery studies in Japan have followed those conducted in the US. The aims of this study were to compare trends in geriatric variables for patients who underwent gastroenterological surgeries between two countries, and to elucidate the characteristics of them.

Geriatric variables and outcomes were analyzed via nationwide databases in both countries. Subjects were defined as patients with age ≥ 65 who underwent seven major gastroenterological surgeries for malignant disease. Basic statistical values were compared between them.

A total of 2703 patients in the National Clinical Database (NCD) and 1342 patients in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) were included. Among preoperative comorbidities, dyspnea, hypertension, bleeding disorder, and emergency cases increased with age in both databases, while the rates of obesity and emergency cases were more frequent in NSQIP. Most postoperative complications were not significantly associated with age in either database. Geriatric-associated preoperative variables and outcomes varied with age in both countries. Cognitive variables (history of dementia, surrogate-signed consent, and delirium) were similar between the two databases. However, mobility elements (use of mobility aid, fall history, high fall risk, and new use of mobility aid) and postoperative functional dependency were more frequent in NSQIP than NCD.

Geriatric-associated variables and outcomes changed similarly with age in both countries, while mobility and function were different between the two.