Page 75 - Risk quantification and modification in older patients with colorectal cancer

Geriatric risk score and poor surgical outcomes
Other complications consisted of infectious complications, thromboembolic complications, and complications defined as “other”in the DCRA.
Presence of delirium after surgery and destination after discharge (to home or an extended care facility) could not be retrieved from the DCRA and was also extracted from the EMR. Delirium was defined as present when (1) the occurrence was documented in a patient’s medical record by a geriatrician or treating physician, (2) haloperidol was prescribed during hospital stay or (3) Delirium Observation Screening Scale11 ≥3 in three consecutive moments was recorded in the medical record.
Geriatric parameters (used in VMS)
In the participating hospitals, the risk for undernutrition (or at risk of becoming undernourished), physical impairment, the risk of delirium and fall risk were assessed preoperatively by nursing staff with the screening questionnaires. The full 13-item list of the four questionnaires is presented in Appendix A.
Risk for undernutrition was assessed using either the Short Nutritional Assessment Questionnaire (SNAQ)12 or Malnutrition Universal Screening Tool (MUST).13 Increased risk for undernutrition was defined as SNAQ score ≥3 or MUST score ≥2. Functional impairment was assessed with the six-item Katz- activities of daily living (ADL)14 consisting of questions regarding bathing, dressing, using the toilet, eating, transferring from bed to chair and if they used incontinence materials. An impaired score was defined as Katz- ADL score ≥2. Fall risk consisted of one question and was either present or absent. Risk for delirium was assessed using three yes or no questions scoring 1 or 0. Score ≥1 was considered as an increased risk. We kept the cutoff value of 1 for the delirium score as suggested by the national guidelines, as Heim at al. earlier showed its independent association with increased care, worse ADL functioning, and short-term mortality in an unselected group of older hospitalised patients.15
For this study, we composed a cumulative risk score of the VMS, by summing the total number of impairments. All individual domains were included, independent of whether the individual domain was significantly associated with an outcome. Low risk score was defined as a sumscore of 0, an intermediate risk as sumscore of 1 or 2 and a high risk sumscore of 3 or 4.
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