Megan A Feng1, Daniel T McMillan2, Karen Crowell3, Hyman Muss4, Matthew E Nielsen5, Angela B Smith6. 1. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; The Ohio State College of Medicine, Columbus, Ohio. 2. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 3. Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 4. Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Geriatric Oncology, Chapel Hill, North Carolina; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 5. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Geriatric Oncology, Chapel Hill, North Carolina; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 6. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Geriatric Oncology, Chapel Hill, North Carolina; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: angela_smith@med.unc.edu.
Abstract
BACKGROUND: The comprehensive geriatric assessment (CGA) has developed as an important prognostic tool to risk stratify older adults and has recently been applied to the surgical field. In this systematic review, we examined the utility of CGA components as predictors of adverse outcomes among geriatric patients undergoing major oncologic surgery. MATERIALS AND METHODS: MEDLINE, Embase, and the Cochrane Library were searched for prospective studies examining the association of components of the CGA with specific outcomes among geriatric patients undergoing elective oncologic surgery. Outcome parameters included 30-d postoperative complications (POC), mortality, and discharge to a nonhome institution. RESULTS: The initial search identified 178 potentially relevant articles, with six studies meeting inclusion criteria. Deficiencies in instrumental activities of daily living, activities of daily living, fatigue, cognition, frailty, and cognitive impairment were associated with increased POC. No CGA predictors were identified for postoperative mortality whereas frailty, deficiencies in instrumental activities of daily living, and depression predicted discharge to a nonhome institution. CONCLUSIONS: Across a variety of surgical oncologic populations and cancer types, components of the CGA appear to be predictive of POC and discharge to a nonhome institution. These results argue for inclusion of focused geriatric assessments as part of routine preoperative care in the geriatric surgical oncology population.
BACKGROUND: The comprehensive geriatric assessment (CGA) has developed as an important prognostic tool to risk stratify older adults and has recently been applied to the surgical field. In this systematic review, we examined the utility of CGA components as predictors of adverse outcomes among geriatric patients undergoing major oncologic surgery. MATERIALS AND METHODS: MEDLINE, Embase, and the Cochrane Library were searched for prospective studies examining the association of components of the CGA with specific outcomes among geriatric patients undergoing elective oncologic surgery. Outcome parameters included 30-d postoperative complications (POC), mortality, and discharge to a nonhome institution. RESULTS: The initial search identified 178 potentially relevant articles, with six studies meeting inclusion criteria. Deficiencies in instrumental activities of daily living, activities of daily living, fatigue, cognition, frailty, and cognitive impairment were associated with increased POC. No CGA predictors were identified for postoperative mortality whereas frailty, deficiencies in instrumental activities of daily living, and depression predicted discharge to a nonhome institution. CONCLUSIONS: Across a variety of surgical oncologic populations and cancer types, components of the CGA appear to be predictive of POC and discharge to a nonhome institution. These results argue for inclusion of focused geriatric assessments as part of routine preoperative care in the geriatric surgical oncology population.
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