Page 56 - Risk quantification and modification in older patients with colorectal cancer

Chapter 3
The objective of this study was to assess the predictive value of the G8 and ISAR- HP for adverse outcomes after colorectal cancer surgery in elderly patients aged 70 years and older with stage I-III colorectal cancer. Outcomes of interest were postoperative complications, rates of readmissions, early death (30-days) and six- month mortality. Analysis of the best performing screening tool would give insight into patient’s characteristics that are associated with these adverse outcomes.
Patients and methods
Study design
We conducted a cohort study using a prospectively collected database and electronic hospital records. Data was collected from two teaching hospitals in the Netherlands: the Hagaziekenhuis in The Hague and the Diakonessenhuis in Utrecht. The prospectively collected database consisted of data from the Dutch Surgical Colorectal Audit (DSCA) that is also used for quality purposes and collects data from all Dutch patients who had surgery for colorectal carcinoma.18
Patient selection
We identified all patients aged >70 years, who had surgical treatment for colorectal cancer between May 1st 2014 and August 1st 2016. Patients with non-elective surgery, Transanal Endoscopic Microsurgery (TEM), metastatic disease (stage IV) and patients with synchronous cancer were excluded. The primary outcomes of interest were 30-day complication rates, readmission rates and 30-day mortality. Secondary outcomes were the length of hospital stay and six-month mortality
Frailty assessment
In both hospitals, the ISAR-HP and G8 frailty screening questionnaires were part of the workup for older patients with the diagnosis of colorectal cancer. Both screening tools were performed by qualified nurses as part of the diagnostic workup prior to surgery. The G8 questionnaire consists of eight items with a total score ranging from zero to seventeen. It contains questions about food intake, weight loss, mobility, self-evaluation of health status, neuropsychological problems, body mass index (BMI), polypharmacy and age.19 Patients with a score of >14 were regarded as ‘fit’ (G8-fit). Patients with a score of ≤ 14 were regarded as potentially ‘frail’ (G8–frail). The ISAR-HP consists of four questions about the
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