A daily multidisciplinary assessment of older adults undergoing elective colorectal cancer surgery is associated with reduced delirium and geriatric syndromes

Abstract

Objectives: Comprehensive geriatric assessment (CGA) has shown to benefit older patients undergoing urological and orthopedic surgery. However, this approach has been scarcely assessed in patients elected for colorectal surgery.

Materials and methods: Retrospective cohort of patients aged ≥70 years admitted for elective colorectal cancer surgery to a single hospital between 2008 and 2012. Upon admission, patients were assigned to a usual care (UC) plan or a CGA-based care (GS) plan conducted by a multidisciplinary team, according to standard clinical criteria.Analyzed outcomes included the incidence of delirium and other geriatric syndromes during hospital stay, mortality, readmissions, andnumber of perioperative complications.

Results: The cohort included 310 patients, 203 assigned to the GS group and 107 to the UC group. Patients in the GS group had significantly lower Barthel and Lawton scores, higher prevalence of dementia and heart failure, and higher comorbidity burden. Fifty-four (17.5%) patientsexperienced delirium (23 [11.3%] and 31 [29.2%] in the GS and UC groups, respectively; p < .001), and 49 (15.8%) patient experienced other geriatric syndromes (21 [10.3%] and 28 [26.2%] in the GS and UC groups, respectively; p < .001). Serious complications were more frequent in the GS group: 154 (75.9%) vs 60 (56.1%) in the UC group; p < .001. No significant differences were observed between groups regarding readmissions, and in-hospital and post-discharge (1 year follow-up) mortality.

Conclusions: Despite the poorer clinical condition of patients in the GS group, the CGA-based intervention resulted in a lower incidence of delirium and other geriatric syndromes compared with the UC group.

Keywords: Colorectal surgery; Delirium; Frail; Geriatric assessment; Older patients.