(RxWiki News) As the population ages, more older people are having surgery. Careful assessment of the risks before surgery may help these people do better afterwards.
In a recent study, researchers developed a screening test to predict which seniors will recover well from surgery and which seniors may experience more difficulties.
This new screening tool may do a better job than the screening test presently in use, according to the findings of this study.
"Discuss the possible risks of surgery with your surgeon."
This study was led by Sun-wook Kim, MD, of Seoul National University College of Medicine in South Korea.
Between October 2011 and July 2012, the researchers enrolled 275 elderly patients, aged 65 and older, undergoing intermediate-risk or high-risk surgery at one care center that offers highly specialized equipment and expertise. None of the surgeries were emergency operations. Of the 275 patients, 127 were having surgery for a benign disease, and 148 chose surgery for a malignant (cancerous) disease.
All of the patients had a comprehensive geriatric assessment (CGA) prior to surgery. This assessment is a screening tool used to identify frail patients who may not fare as well after surgery as heartier older people.
The researchers wanted to find out how many of these patients died within a year of surgery, and how many had post-op complications such as pneumonia, urinary tract infections, delirium, acute pulmonary thromboembolism (blockage of a blood vessel in the lung) and unplanned admissions to the intensive care unit of the hospital. They were also interested in finding out who would spend the most time recovering in hospital and who would need to go to a nursing facility after surgery.
During the follow-up period, 25 patients died. Patients in the survival group tended to be heavier and had predominantly non-cancerous disease.
Another 29 patients had at least one post-op complication, and 24 were discharged to nursing facilities rather than home.
The researchers found that the model they used to predict outcomes was better at foreseeing problems than the American Society of Anesthesiologists' classification that is the standard.
The researchers developed a multidimensional frailty score (MFS) model to predict unfavorable outcomes after surgery. They used results of the CGA, other patient characteristics and laboratory variables. The researchers used the Charlson Comorbidity index (a method to classify other medical problems that might increase risk for death), dependence in activities of daily living and dependence in instrumental activities of daily living. Instrumental actives are not necessary for living but allow a person to live independently, such as having the ability to manage money or do housework. Other factors included in the index were dementia, risk of delirium, short mid-arm circumference and malnutrition.
The MFS helped predict longer hospital stay, greater risk of death or need for discharge to a nursing facility in elderly patients after surgery.
“This model may support surgical treatments for fit older patients at low risk of complications, and it may also provide an impetus for better management of geriatric patients with a high risk of adverse outcomes after surgery,” the authors concluded.
In an accompanying commentary on this study, Michael Zenilman, MD, of the Johns Hopkins School of Medicine in Bethesda, Maryland, wrote that this research is important for two reasons. For one, it is part of a current series that focuses on geriatric indicators for determining the risk of surgery in elderly patients. Secondly, “their study is one of few I have seen proving that a well-crafted comprehensive geriatric assessment can be a more powerful predictor of perioperative [surgical] risk than the time-honored American Society of Anesthesiology score.”
This study appears in JAMA Surgery.
The study authors disclosed no conflicts of interest.
