Pre-surgical Geriatric Syndromes, Frailty, and Risks for Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: Prevalence and Red Flags

Cheryl Chia Hui Chen*, Ming Tsan Lin, Jin Tung Liang, Chun Min Chen, Chung Jen Yen, Guan-Hua Huang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Objective: We sought to identify and evaluate red flags for pre-surgical geriatric conditions (geriatric syndromes, frailty, and risks for postoperative delirium) in older patients undergoing gastrointestinal surgery. Methods: Older individuals (≥65 years) undergoing major elective gastrointestinal surgery from 2009 to 2012 were enrolled and assessed preoperatively. Results: Participants (N = 379; mean age = 74.5 ± 5.9 years) primarily underwent colorectal (54.3 %), gastric (21.9 %), and pancreatobiliary (12.6 %) surgery. Overall, 30.9 % had existing geriatric syndromes, 26.7 % were frail, and 22.8 % had >3 risk factors for postoperative delirium. The largest proportion (45.7 %) presented with at least one geriatric condition. Patients with or without geriatric conditions were discriminated with adequate sensitivity (67 %), specificity (84 %), and positive predictive value (77 %) by eight red flags: age ≥75 years (OR, 2.86; P < 0.001), eating soft food (OR, 3.63; P = 0.001), reported hypertension (OR, 2.8; P = 0.001), weight loss >3 kg (OR, 4.79; P < 0.001), fair-to-weak grip strength (OR, 2.53; P = 0.001), sleeplessness (OR, 2.57; P = 0.001), no-better-than-peer perceived health (OR, 1.88; P = 0.022), and short-term inability to recall two of three common words (OR, 1.81; P = 0.025). Conclusions: Eight red flags covered as part of history and physical examination are well suited to screen patients for geriatric conditions indicating the need for preoperative geriatric assessments and optimization.

Original languageEnglish
Pages (from-to)927-934
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number5
DOIs
StatePublished - 1 May 2015

Keywords

  • Delirium
  • Frailty
  • Geriatric syndromes
  • Preoperative risk assessment
  • Screening

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