title: Burden of Geriatric Events Among Older Adults Undergoing Major Cancer Surgery.
abstract: OBJECTIVE
  Most malignancies are diagnosed in older adults who are potentially susceptible to aging-related health conditions; however, the manifestation of geriatric syndromes during surgical cancer treatment is not well quantified. Accordingly, we sought to assess the prevalence and ramifications of geriatric events during major surgery for cancer.
  
  
  METHODS
  Using Nationwide Inpatient Sample data from 2009 to 2011, we examined hospital admissions for major cancer surgery among elderly patients (ie, age ≥ 65 years) and a referent group age 55 to 64 years. From these observations, we identified geriatric events that included delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. We then estimated the collective prevalence of these events according to age, comorbidity, and cancer site and further explored their relationship with other hospital-based outcomes.
  
  
  RESULTS
  Within a weighted sample of 939,150 patients, we identified at least one event in 9.2% of patients. Geriatric events were most common among patients age ≥ 75 years, with a Charlson comorbidity score ≥ 2, and who were undergoing surgery for cancer of the bladder, ovary, colon and/or rectum, pancreas, or stomach (P < .001). Adjusting for patient and hospital characteristics, those patients who experienced a geriatric event had a greater likelihood of concurrent complications (odds ratio [OR], 3.73; 95% CI, 3.55 to 3.92), prolonged hospitalization (OR, 5.47; 95% CI, 5.16 to 5.80), incurring high cost (OR, 4.97; 95% CI, 4.58 to 5.39), inpatient mortality (OR, 3.22; 95% CI, 2.94 to 3.53), and a discharge disposition other than home (OR, 3.64; 95% CI, 3.46 to 3.84).
  
  
  CONCLUSIONS
  Many older patients who receive cancer-directed surgery experience a geriatric event, particularly those who undergo major abdominal surgery. These events are linked to operative morbidity, prolonged hospitalization, and more expensive health care. As our population ages, efforts focused on addressing conditions and complications that are more common in older adults will be essential to delivering high-quality cancer care.
authors.affiliation: Hung-Jui Tan, Debra Saliba, Lorna Kwan, Alison A. Moore, and Mark S. Litwin, University of California, Los Angeles; and Debra Saliba, Greater Los Angeles VA Geriatric Research Education and Clinical Centers, Los Angeles, CA. htan@mednet.ucla.edu.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Hung-Jui Tan, Debra Saliba, Lorna Kwan, Alison A. Moore, and Mark S. Litwin, University of California, Los Angeles; and Debra Saliba, Greater Los Angeles VA Geriatric Research Education and Clinical Centers, Los Angeles, CA.
authors.forename: Debra
authors.initials: D
authors.lastname: Saliba
authors.affiliation: Hung-Jui Tan, Debra Saliba, Lorna Kwan, Alison A. Moore, and Mark S. Litwin, University of California, Los Angeles; and Debra Saliba, Greater Los Angeles VA Geriatric Research Education and Clinical Centers, Los Angeles, CA.
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.affiliation: Hung-Jui Tan, Debra Saliba, Lorna Kwan, Alison A. Moore, and Mark S. Litwin, University of California, Los Angeles; and Debra Saliba, Greater Los Angeles VA Geriatric Research Education and Clinical Centers, Los Angeles, CA.
authors.forename: Alison A
authors.initials: AA
authors.lastname: Moore
authors.affiliation: Hung-Jui Tan, Debra Saliba, Lorna Kwan, Alison A. Moore, and Mark S. Litwin, University of California, Los Angeles; and Debra Saliba, Greater Los Angeles VA Geriatric Research Education and Clinical Centers, Los Angeles, CA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D017281:Cost of Illness; D003681:Dehydration / Q000453:epidemiology; D003693:Delirium / Q000453:epidemiology; D005183:Failure to Thrive / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D003668:Pressure Ulcer / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012494:Sampling Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology