Page 92 - Risk quantification and modification in older patients with colorectal cancer

Chapter 5
care for all patients of 70 years and over, with geriatric screening and subsequent geriatric assessment in case of possible frailty. The Enhanced Recovery After Surgery (ERAS) guidelines12 were part of standard care for all surgical patients.
Patients with abdominal CT imaging as part of preoperative staging prior to colorectal surgery were eligible for inclusion. Exclusion criteria were acute surgery, transanal endoscopic microsurgery (TEM), stage IV CRC or synchronous cancer at the time of diagnosis.
This study was approved by the local Medical Ethical Review Board Zuidwest- Holland, the Netherlands. A waiver for informed consent was granted.
Data collection
The DCRA provided the demographic data as well as pre- and postoperative outcome data on all surgically treated patients. We retrieved the following demographic data: gender, age, height and length, American Society of Anesthesiologists physical status classification (ASA score), Charlson comorbidity index (CCI)13, Body Mass Index, tumour location and pathological tumour stage (according to AJCC, 7th edition). Also, preoperative information on Activities of Daily Living (Katz ADL questionnaire)14 and any preoperative use of a mobility aid (the use of a cane, crutches, a walking frame and wheelchair) were collected from the electronic medical records (EMRs). Preoperative use of a mobility aid was assessed by a single yes or no question. All parameters were all registered as part of standard preoperative care. Complications were defined as in-and-out of hospital morbidity within 30-days of surgery.
In the DCRA, the number of complications refers to the number of patients with one or more complications. Surgical complications included wound infections, ileus and complications that needed (surgical) intervention (including anastomotic leaks). Cardiopulmonary complications consisted of pulmonary complications (pneumonia, atelectasis, pulmonary embolism, pulmonary insufficiency or other pulmonary complications) and cardiac complications (myocardial infarction, heart failure, arrhythmia, angina pectoris, cardiac arrest or other cardiac complications). Details concerning the length of hospital stay, ICU-admission, 30-day readmissions and 30-day mortality and data on adjuvant treatment were also retrieved. Also, discharge status (to home or an extended care facility) was retrieved from the EMRs.
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