Page 62 - Risk quantification and modification in older patients with colorectal cancer

Chapter 3
Table 2 shows primary and secondary outcomes for frail versus non-frail patients depending on the ISAR-HP, the G8 and both screening tools combined. The G8 had no predictive value for the primary outcomes. However ISAR-HP-frail patients had a 2.4 times (95% CI 1.1-5.4) higher odds for complications with more cardiopulmonary complication 19% versus 4% (OR 5.9, 95% CI 1.6-22.6) with higher rates of readmissions within 30 days after discharge: 19% versus 6% in the non-frail OR 3.4 (95% CI 1.1-11.0). Combining the two screening tools resulted in predictive value for readmissions OR 5.4 (95% CI 1.5-18.6) and 6.7 times increased odds for 30-day mortality (95% CI 1.3-36.0). ISAR HP had no predictive value for anastomotic leakage, delirium or ‘other’ complications.
For the secondary outcomes, ISAR-HP-frail patients were significantly at risk for a longer length of hospital stay (10.3 versus 8.9 days in non-frail patients, p = 0.01) and a total of seven patients (5%) died within six months of follow-up. Five of these (71%) died due to complications after surgery. One patient with a history of cardiac failure developed postoperative cardiac and respiratory failure and declined further treatment. No cause of death was retrieved for one patient. ISAR-HP frail patients had a 4.9 (95 % CI 1.1-24.1) higher odds for dying within six months of surgery. Patients who were frail on both ISAR-HP and G8 had a 9.5 (95% CI 1.9-47.4) higher odds for six months mortality compared to non-frail patients. The G8 alone was not associated with any of the secondary outcomes.
Subgroup analysis
Subgroup analysis of all 214 patients (screened and non-screened) found that patients with a CCI score ≥2 were at risk for 1 or more complications (surgical and non-surgical) after surgery with an OR of 2.1 (95% CI 1.1-3.9) when corrected for the potential confounders: age, gender, ASA score and tumour stage. We found no association of co-morbidities or ASA score with the risk of readmission, 30-day or six-months mortality.
Discussion
This cohort study using a prospectively collected database investigated the predictive value of G8 and ISAR-HP questionnaires for adverse outcomes after surgery in older colorectal cancer patients in two teaching hospitals in the Netherlands. The results show that ISAR-HP frail patients were at increased risk for 30-day complications,
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