ASSOCIATION OF GERIATRIC MEASURES WITH SURGICAL OUTCOMES IN COLORECTAL SURGERY PATIENTS
Margaret Johnson*, Lauren Wood, Robert H. Hollis, Drew J. Gunnells, Jamie A. Cannon, Karin M. Hardiman, Daniel I. Chu, Gregory D. Kennedy, Melanie S. Morris
The University of Alabama at Birmingham Department of Surgery, Birmingham, AL
Introduction: As our population ages, it is vital that surgical care be safe for older adult patients. This year the American College of Surgeons launched the Geriatric Surgery Verification Program which requires preoperative assessment of older patients. The purpose of this study is to examine associations of 3 validated geriatric measures with surgical outcomes to determine if these assessments accurately predict outcomes in the colorectal surgery population.
Methods: For this retrospective study of prospectively collected data, we queried National Surgical Quality Improvement Program (NSQIP) participant use file for all older adult patients (age 65 years or older) undergoing colorectal surgery from August 2018 to October 2020. Patients were categorized based on results of 3 geriatric assessments which are performed during pre-operative anesthesia evaluation at our hospital: Katz Index of Independence in Activities of Daily Living, Six-Item Screen for Dementia, and Mini Nutritional Assessment. Patients with normal screens were categorized as full function and patients with an abnormal result on any of the 3 screens were categorized as impaired. Primary outcomes were length of stay, readmission rate, and post-operative complications. Continuous variables used Kruskal-Wallis test and categorical variables used Chi-Squared tests with an alpha level of 0.05.
Results: Our study included 172 patients with median age of 72 years (68.1-77.7) and 58% female. Of 172 patients, 121 (73.8%) were full function and 45 (26.2%) were impaired. Between the two groups, there were no significant differences in age, BMI, or smoking status. Most patients were ASA class 3 (84.8%) and there was no significant different in ASA classification between the two groups. Analysis revealed that there were no significant differences in median length of stay between the two groups: full function 4 days (3.0 - 5.0) vs impaired 4 days (3.0 - 5.0) [p=0.58]. There were no significant differences in 30-day readmission rates: full function 14.2% vs impaired 13.3% [p=0.89]. There were no significant differences in overall 30-day complications: full function 22.8% vs impaired 17.8% [p=0.48]. Additionally, there were no significant differences in any NSQIP assessed complication including cardiac, respiratory, or wound related complications.
Conclusion: Older adult patients with some impaired independence, cognition, or nutrition as measured by commonly accepted geriatric screens had no significant difference in length of stay, 30-day readmission rates, or post-operative complications following colorectal surgery. Further work is needed to understand the association between specific geriatric screens and outcomes in colorectal surgery patients. Identification of these assessment would allow development of interventions that can be performed before surgery to improve post-operative outcomes.
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