title: Evaluation of preoperative geriatric assessment of elderly patients with colorectal carcinoma. A retrospective study.
abstract: OBJECTIVE
  Elderly patients with colorectal carcinoma are screened with the Identification of Seniors at Risk (ISAR) questionnaire to identify frail patients. These patients are more at risk for mortality and morbidity and are referred to the geriatric specialist for assessment (Dutch acronym: DOG). The DOG assessment aims to preoperatively optimize the patient in order to improve postoperative outcomes. This study evaluates if the DOG assessment influences postoperative outcome after colorectal surgery.
  
  
  METHODS
  Retrospective cohort and match-control study. Elderly patients who underwent elective resection between 01-01-2008 and 01-08-2013 in the Medical Centre Alkmaar were included. Patients with a positive ISAR score were referred to the geriatric specialists for DOG assessment (DOG patients). DOG assessment encompassed comprehensive geriatric assessment and interventions.
  
  
  METHODS
  Mortality, delirium and length of hospital stay.
  
  
  RESULTS
  postoperative complications.
  Cohort ISAR- (2008-2010, no ISAR questionnaire) is compared with cohort ISAR+ (2011-2013, ISAR questionnaire). Match-control comparison: DOG patients are compared with matched controls from cohort ISAR-.
  
  
  RESULTS
  Compared to their matched controls, DOG patients were older and had a higher prevalence of certain risk factors for postoperative delirium. In both comparisons, no statistical significant differences were found between the groups in mortality and postoperative delirium. Length of stay was significantly shorter in cohort ISAR+.
  
  
  CONCLUSIONS
  While the DOG patients were significantly more at risk for postoperative complications, the DOG patients had comparable postoperative outcomes as their matched controls. We therefore conclude that the DOG assessment has a positive influence on the postoperative outcomes after colorectal surgery.
authors.affiliation: Department of Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands. Electronic address: r.indrakusuma@mca.nl.
authors.forename: R
authors.initials: R
authors.lastname: Indrakusuma
authors.affiliation: Department of Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
authors.forename: M S
authors.initials: MS
authors.lastname: Dunker
authors.affiliation: Department of Geriatric Medicine, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Peetoom
authors.affiliation: Department of Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
authors.forename: W H
authors.initials: WH
authors.lastname: Schreurs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000601:surgery*; D003693:Delirium / Q000453:epidemiology*; D013505:Digestive System Surgical Procedures; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: Aged; Colorectal neoplasms; Delirium; Frail elderly; Geriatric assessment; Mortality