Page 72 - Risk quantification and modification in older patients with colorectal cancer

Chapter 4
Abstract
Introduction: VMS is a Dutch risk assessment tool for hospitalised older adults that includes a short evaluation of four geriatric domains: risk for delirium, risk for undernutrition, risk for physical impairments, and fall risk. We investigated whether the information derived from this tool has prognostic value for outcomes of colorectal cancer (CRC) surgery.
Patients and methods: All consecutive patients over age 70 years who underwent elective CRC surgery in three Dutch hospitals (2014-2016) were studied. The presence of risk was scored prior to surgery and per geriatric domain as either 0 (risk absent) or 1 (risk present). The total number of geriatric risk factors was summed. The primary outcome was long-term survival. Secondary outcomes were postoperative complications, including delirium. Cox proportional hazards models were used to evaluate the sumscore and risk factors associated with overall survival (OS).
Results: Five hundred fifty patients were included. Median age was 76.5 years and median follow-up was 870 days. Patients with intermediate (1-2) or high (3-4) sumscore were independently associated with lower overall survival: intermediate sumscore HR 1.9 (95% Confidence Interval (CI) 1.1-3.5; p=0.03) and high sumscore HR 8.7 (95% CI 4.0-19.2; p<0.001), respectively. Sumscores were also associated with postoperative complications (intermediate sumscore OR 1.8; 95% CI 1.2-2.7 and high sumscore OR 2.4; 95% CI 1.02-5.5).
Conclusions: This easy-to-use geriatric sumscore has strong associations with long term outcome and morbidity after CRC surgery. This information may be included in risk models for morbidity and mortality and can be used in shared decision making.
70