부산대학교 도서관

BACKGROUND: The purpose of this prospective study was to identify risk factors for adverse outcomes or increased resource utilization after abdominal cancer surgery in geriatric patients. METHODS: Baseline clinical and geriatric assessment variables including functional status, nutritional status, comorbidity index, mental status, depression scale score, fatigue inventory scale, and polypharmacy scale were prospectively recorded for patients age ≥65 undergoing intra-abdominal oncologic surgery. Outcome variables included morbidity, mortality, discharge to nursing facility, prolonged hospital stay, and readmission. RESULTS: Of 111 patients, surgery type was colorectal in 40%, hepatopancreatobiliary in 30%, and gastric/duodenal in 14%. Variables associated with discharge to a nursing facility on multivariate analysis included weight loss ≥10% (OR 6.52 [95% CI: 1.43–29.76], P = 0.02), ASA score ≥2 (OR 5.08 [1.13–22.77], P = 0.03), and ECOG score ≥2 (OR 4.51 [1.03–19.71], P = 0.04). Variables independently associated with prolonged hospital stay included weight loss ≥10% (OR 4.03 [1.13–14.43], P = 0.03), the presence of polypharmacy (OR 2.45 [1.09–5.48], P = 0.03), and distant disease (OR 0.37 [0.15–0.91], P = 0.03). No variables were associated with morbidity or readmission. CONCLUSIONS: Pre-operative clinical and geriatric assessment tools can help predict the need for discharge to a nursing facility or increased length of stay. Future studies will be required to identify patients suitable for interventions to decrease hospital and post-discharge resource utilization. J. Surg. Oncol. 2013; 108:182–186. © 2013 Wiley Periodicals, Inc.