Page 57 - Risk quantification and modification in older patients with colorectal cancer
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                                Risk stratification using ISAR-HP and G8 screening tools
need for assistance in instrumental activities of daily living (iADL), travelling, use of a walking device and about education. Scores range from 0 to 2 points with a maximum total score of 5. Patients with a score of <2 were regarded as ‘fit’ (ISAR- HP-fit), Appendix A. A cut-off score of ≥2 is defined as abnormal; these patients were regarded as potentially ‘frail’ (ISAR-HP-frail), Appendix B.
Data collection
Data retrieved from the DSCA database included the following patient information: age, Body Mass Index (BMI; kg/m2), Charlson Comorbidity Index (CCI),10 American Society of Anaesthesiologist (ASA) score,20 tumour location, preoperative tumour complications, tumour stage (TNM 5th edition), (neo) adjuvant treatment (radiotherapy/chemoradiation or chemotherapy) and type of resection (classified as open or laparoscopic resection). Moreover, surgical and non-surgical complications are defined as complications within 30 days of surgery. Surgical complications that needed reintervention are being registered separately and include anastomotic leakage. Non-surgical complications are registered as 1) cardiac, 2) pulmonary, 3) neurological, 4) thrombo-embolic, 5) infectious and 6) ‘other’ complications that occurred after surgery. A patient having 2 pulmonary and 2 infectious complications post surgery is registered as 1 pulmonary complication and 1 infectious complication. Additionally all re-interventions, length of hospital stay, 30-day readmissions and 30-day mortality are entered. Data entry in this database is done by a qualified data-entry manager or nurse.
From electronic hospital records, the following data was extracted from the day of admission prior to surgery: Katz Index of Independence in Activities of Daily Living (Katz-6)21 with a cut-off ≥2 considered as activities of daily living dependent, the use of a walking device, reported falls within the 6 months before surgery, impaired malnutrition screening scores from the Short Nutritional Assessment Questionnaire (SNAQ; cut-off ≥2)22 or Malnutrition Universal Screening Tool (MUST; cut-off ≥1),23 self-reported cognitive impairment.
In addition a delirium was registered as complication separately when it was recorded in the electronic hospital record as such by the treating or consulting physician. When applicable, the cause of death was also extracted. Trough a linkage with the Municipal Personal Records Database, the exact date of death was retrieved and six-month mortality (182-days) was calculated from the
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