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BACKGROUND: The purpose of this prospective study was to identify risk factors for adverse outcomes or increased resource utilization after abdominal cancer surgery in geriatric patients. METHODS: Baseline clinical and geriatric assessment variables including functional status, nutritional status, comorbidity index, mental status, depression scale score, fatigue inventory scale, and polypharmacy scale were prospectively recorded for patients age ≥65 undergoing intra-abdominal oncologic surgery. Outcome variables included morbidity, mortality, discharge to nursing facility, prolonged hospital stay, and readmission. RESULTS: Of 111 patients, surgery type was colorectal in 40%, hepatopancreatobiliary in 30%, and gastric/duodenal in 14%. Variables associated with discharge to a nursing facility on multivariate analysis included weight loss ≥10% (OR 6.52 95% CI: 1.43-29.76, P = 0.02), ASA score ≥2 (OR 5.08 1.13-22.77, P = 0.03), and ECOG score ≥2 (OR 4.51 1.03-19.71, P = 0.04). Variables independently associated with prolonged hospital stay included weight loss ≥10% (OR 4.03 1.13-14.43, P = 0.03), the presence of polypharmacy (OR 2.45 1.09-5.48, P = 0.03), and distant disease (OR 0.37 0.15-0.91, P = 0.03). No variables were associated with morbidity or readmission. CONCLUSIONS: Pre-operative clinical and geriatric assessment tools can help predict the need for discharge to a nursing facility or increased length of stay. Future studies will be required to identify patients suitable for interventions to decrease hospital and post-discharge resource utilization.
Badgwell et al. (Wed,) studied this question.