title: Pre-surgical Geriatric Syndromes, Frailty, and Risks for Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: Prevalence and Red Flags.
abstract: OBJECTIVE
  We sought to identify and evaluate red flags for pre-surgical geriatric conditions (geriatric syndromes, frailty, and risks for postoperative delirium) in older patients undergoing gastrointestinal surgery.
  
  
  METHODS
  Older individuals (≥65 years) undergoing major elective gastrointestinal surgery from 2009 to 2012 were enrolled and assessed preoperatively.
  
  
  RESULTS
  Participants (N=379; mean age=74.5 ± 5.9 years) primarily underwent colorectal (54.3 %), gastric (21.9 %), and pancreatobiliary (12.6 %) surgery. Overall, 30.9 % had existing geriatric syndromes, 26.7 % were frail, and 22.8 % had >3 risk factors for postoperative delirium. The largest proportion (45.7 %) presented with at least one geriatric condition. Patients with or without geriatric conditions were discriminated with adequate sensitivity (67 %), specificity (84 %), and positive predictive value (77 %) by eight red flags: age ≥75 years (OR, 2.86; P<0.001), eating soft food (OR, 3.63; P=0.001), reported hypertension (OR, 2.8; P=0.001), weight loss >3 kg (OR, 4.79; P<0.001), fair-to-weak grip strength (OR, 2.53; P=0.001), sleeplessness (OR, 2.57; P=0.001), no-better-than-peer perceived health (OR, 1.88; P=0.022), and short-term inability to recall two of three common words (OR, 1.81; P=0.025).
  
  
  CONCLUSIONS
  Eight red flags covered as part of history and physical examination are well suited to screen patients for geriatric conditions indicating the need for preoperative geriatric assessments and optimization.
authors: Department of Nursing, College of Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan, cherylchen@ntu.edu.tw.
authors: Cheryl Chia-Hui
authors: CC
authors: Chen
authors: Ming-Tsan
authors: MT
authors: Lin
authors: Jin-Tung
authors: JT
authors: Liang
authors: Chun-Min
authors: CM
authors: Chen
authors: Chung-Jen
authors: CJ
authors: Yen
authors: Guan-Hua
authors: GH
authors: Huang
mesh_terms: D000368:Aged; D003693:Delirium / Q000453:epidemiology / Q000209:etiology*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D013577:Syndrome
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