Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer

Importance: Collaboration between geriatricians and surgeons in the perioperative treatment of older patients has been associated with improved outcomes in several nononcologic specialties. Similar associations may be possible among older patients with cancer. Objective: To investigate the associations of geriatric comanagement of care for older patients undergoing cancer-related surgical treatment with 90-day postoperative mortality, rate of adverse surgical events, and postoperative use of inpatient supportive care services. Design, Setting, and Participants: This retrospective cohort study assessed outcomes of patients who received geriatric comanaged care vs those who did not using multivariable logistic regression analysis, with 90-day mortality as the outcome and geriatric comanagement of care as the main variable, with adjustment for age, sex, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index score, preoperative albumin level, operative time, and estimated blood loss. A similar model was used to assess the association of geriatric comanagement with adverse surgical events, defined as any major complication, readmission, or emergency department visit within 30 days. Patients aged 75 years and older who underwent an elective surgical procedure with a hospital stay of at least 1 day at a single tertiary-care cancer center between February 2015 and February 2018 were included. Data were analyzed from January to July 2019. Exposures: Postoperative care comanaged by the geriatrics service and surgical service (geriatric comanagement group) vs by the surgical service only (surgical service group). Main Outcomes and Measures: 90-day mortality, adverse surgical events, and use of supportive care services. Results: Of 1892 patients included, 1020 (53.9%) received geriatric comanagement of care; these patients, compared with those who received care managed by the surgery service only, were older (mean SD age, 81 4 years vs 80 4 years; P < .001), had longer operative time (mean SD, 203 146 minutes vs 138 112 minutes; P < .001), and longer length of stay (median interquartile range, 5 3-8 days vs 4 2-7 days; P < .001). There were no differences in the proportions of men (488 47.8% men vs 450 51.6% men; P = .11). Adverse surgical events were not significantly different between groups (odds ratio, 0.93 95% CI, 0.73-1.18; P = .54). However, the adjusted probability of death within 90 days after surgical treatment was 4.3% for the geriatric comanagement group vs 8.9% for the surgical service group (difference, 4.6% 95% CI, 2.3%-6.9%; P < .001). Additionally, compared with patients who received postoperative care management from the surgery service only, a higher proportion of patients in the geriatric comanagement group received inpatient supportive care services, including physical therapy (555 patients 63.6% vs 820 patients 80.4%; P < .001), occupational therapy (220 patients 25.2% vs 385 patients 37.7%; P < .001), speech and swallow rehabilitation (42 patients 4.8% vs 86 patients 8.4%; P = .002), and nutrition services (637 patients 73.1% vs 803 patients 78.7%; P = .004). Conclusions and Relevance: This cohort study found that geriatric comanagement was associated with significantly lower 90-day postoperative mortality among older patients with cancer. These findings suggest that such patients may benefit from geriatric comanagement, which could improve their ability to survive adverse postoperative events.