Components of geriatric assessments predict thoracic surgery outcomes.
BACKGROUND
No tool currently exists to rapidly allow surgeons to objectively quantify surgical risk in geriatric patients. The goal of our prospective study was to determine if individual questions extracted from validated screens for common geriatric syndromes would have predictive value for surgical risk in geriatric patients with thoracic neoplasms.


METHODS
Patients ≥ 70 y old were recruited to participate in a prospective, IRB-approved study involving the preoperative administration of validated screening tests. Patients were given the geriatric depression scale (GDS), nutrition screening initiative nutritional health checklist (NSI NHC), mini mental status exam (MMSE), brief fatigue inventory (BFI), and assessed for activities of daily living (ADLs) and instrumental activities of daily living (IADLs). All patients enrolled in this study were scheduled for thoracic surgery.


RESULTS
Patients who responded to having a dependency in the IADL "shopping" were more likely to have major complications and to be discharged to a non-home location than those without a dependency (P = 0.011, 0.003). Patients who answered "yes" to questions 1, 9, and 10 of the NSI NHC had a longer mean length of stay compared with patients who answered "no" (P = 0.039, 0.010, 0.031). Answering "yes" to GDS question 2 correlated with the incidence of major complications (r = 0.270 P = 0.037). Answering "yes" to GDS question 12 increased the likelihood of being discharged to a non-home location postoperatively (odds ratio = 11.64, 95% CI, 0.68-202.86, P = 0.047).


CONCLUSIONS
Our data indicate that an abbreviated, rapid presurgical assessment can be developed for estimating operative risk, length of stay, and discharge destination in geriatric patients with thoracic malignancies using individual questions from previously validated screening tools.
Kothari
Anai
A
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA. kothari@wisc.edu
Phillips
Sarah
S
Bretl
Traci
T
Block
Kierstyn
K
Weigel
Tracey
T
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015596:Nutrition Assessment; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*