Page 122 - Risk quantification and modification in older patients with colorectal cancer

Chapter 6
Table 3A Score chart geriatric colorectal (GerCRC) model
Characteristic
Male gender
COPD/Asthma/Emphysema Previous PE or DVTa
Rectal cancer
Mobility Aid
Previous delirium
Need for ADL assistance Polypharmacy
Total Score (add all)
Probability of developing a severe complication (Table 3B).
Scores 2 2
2 1
2 2 1 2
%
a PE. pulmonary Embolism; DVT. Deep Venous Thrombosis
Table 3B Probability of severe complications after CRC surgery in relation to the sum score from Table 3A
Score from table 3A events/No. Cases 0-1 18/217
Predicted Sensitivitya Specificitya + LRb - LRb 10% 1 0 1-
2
3
4
5
6
7-or higher
28/293 20/139 37/198 11/86 23/80 34/75
13% 0.89
14% 0.73
17% 0.61 19% 0.40 23% 0.33 31% 0.20
0.22 1.14 0.49 0.51 1.48 0.53 0.64 1.69 0.61 0.81 2.11 0.74 0.89 3.12 0.75 0.96 4.45 0.84
a Sensitivity and Specificity based on the development cohort bLR. Likelihood ratio. + positive . - negative
Discussion
This study set out to establish what factors are associated with severe postoperative complications after CRC surgery in order to develop a preoperative clinical prediction model for older patients. Based on tumour and preoperative registry and geriatric data of 1088 patients, the use of a mobility aid, risk factor for delirium, and polypharmacy were identified as strong and important predictors for severe complications after surgery for CRC. Adding geriatric predictors to demographic
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