Risk stratification for surgical outcomes in older colorectal cancer patients using ISAR-HP and G8 screening tools

Esteban T D Souwer; Norbert M Verweij; Frederiek van den Bos; Esther Bastiaannet; Rob M E Slangen; Willem H Steup; Marije E Hamaker; Johanna E A Portielje

doi:10.1016/j.jgo.2017.09.003

Risk stratification for surgical outcomes in older colorectal cancer patients using ISAR-HP and G8 screening tools

J Geriatr Oncol. 2018 Mar;9(2):110-114. doi: 10.1016/j.jgo.2017.09.003. Epub 2017 Nov 10.

Authors

Esteban T D Souwer¹, Norbert M Verweij², Frederiek van den Bos³, Esther Bastiaannet⁴, Rob M E Slangen⁵, Willem H Steup⁶, Marije E Hamaker², Johanna E A Portielje⁷

Affiliations

¹ Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands. Electronic address: e.souwer@hagaziekenhuis.nl.
² Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands.
³ Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands.
⁴ Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
⁵ Department of Gastroenterology, Haga Hospital, The Hague, The Netherlands.
⁶ Department of Surgery, Haga Hospital, The Hague, The Netherlands.
⁷ Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands; Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.

PMID: 29129470
DOI: 10.1016/j.jgo.2017.09.003

Abstract

Background: Older patients are at risk for adverse outcomes after surgical treatment of cancer. Identifying patients at risk could affect treatment decisions and prevent functional decline. Screening tools are available to select patients for Geriatric Assessment. Until now their predictive value for adverse outcomes in older colorectal cancer patients has not been investigated.

Objective: To study the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) screening tools for adverse outcomes after elective colorectal surgery in patients older than 70years. Primary outcomes were 30-day complication rates, secondary outcomes were the length of hospital stay and six-month mortality.

Study design and methods: Multicentre cohort study from two hospitals in the Netherlands. Frail was defined as a G8 ≤14 and/or ISAR-HP ≥2. Odds ratio (OR) is given with 95% CI.

Results: Overall, 139 patients (52%) out of 268 patients were included; 32 patients (23%) were ISAR-HP-frail, 68 (50%) were G8-frail, 20 were frail on both screening tools. Median age was 77.7years. ISAR-HP frail patients were at risk for 30-day complications OR 2.4 (CI 1.1-5.4, p=0.03), readmission OR 3.4 (1.1-11.0), cardiopulmonary complications OR 5.9 (1.6-22.6), longer hospital stay (10.3 versus 8.9day) and six-months mortality OR 4.9 (1.1-23.4). When ISAR-HP and G8 were combined OR increased for readmission, 30-day and six-months mortality. G8 alone had no predictive value.

Conclusions: ISAR-HP-frail patients are at risk for adverse outcomes after colorectal surgery. ISAR-HP combined with G8 has the strongest predictive value for complications and mortality.

Key points: Patients screening frail on ISAR-HP are at increased risk for morbidity and mortality. Screening results of G8 alone was not predictive for postoperative outcomes. Predictive value increased when G8 and ISAR-HP were combined.

Keywords: Colorectal cancer; Frailty; G8; ISAR-HP; Surgery.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Colorectal Neoplasms / mortality
Colorectal Neoplasms / surgery*
Female
Frailty / diagnosis*
Frailty / epidemiology
Geriatric Assessment / methods*
Humans
Length of Stay / statistics & numerical data
Male
Outcome Assessment, Health Care / statistics & numerical data
Patient Readmission / statistics & numerical data
Postoperative Complications / epidemiology*
Predictive Value of Tests
Prospective Studies
Risk Assessment / methods