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Title: Short and long-term prognostic value of individual elements of the Comprehensive Geriatric Assessment in the group of patients over 65 years of age undergoing abdominal surgery
Abstract:
Introduction: With an ageing patient population, we are increasingly faced with the challenge of providing optimal surgical care for individuals in the oldest age groups. The Comprehensive Geriatric Assessment (CGA) has become a key tool in identifying risk factors and potential benefits associated with abdominal surgeries in older patients. Although numerous studies have confirmed the importance of CGA, there is still a need for a better understanding of how individual components influence short- and long-term postoperative outcomes. Analysing and synthesising knowledge in this area is essential not only for surgeons and geriatricians, but also for a wide range of specialists involved in caring for older adults. Therefore, the aim of the three-part series was to analyse the utility of CGA components in predicting complications in both short- and longterm outcomes in patients aged 65 and older undergoing elective abdominal surgeries for noncancer and cancer-related conditions. Specific Objectives: □ Analysis of the utility of comprehensive geriatric assessment and its individual components in predicting postoperative complications in older patients undergoing laparoscopic surgeries — systematic literature review. □ Analysis of the utility of comprehensive geriatric assessment components in predicting short- and long-term postoperative outcomes in older oncologic patients underg ; oing abdominal surgeries. □ Analysis of the utility of comprehensive geriatric assessment components in predicting short- and long-term postoperative outcomes in older patients requiring laparoscopic cholecystectomy. 41 Materials and Methods The first article is a systematic literature review from 2009 to 2020 regarding the components of Comprehensive Geriatric Assessment in assessing the risk of complications in older patients undergoing laparoscopic surgeries. Ultimately, 10 studies were included in the review, comprising a total of 1940 patients aged 65 years and older. The remaining two articles are prospective studies of our own population of oncologic patients undergoing abdominal surgeries and patients undergoing laparoscopic cholecystectomy. In the case of the first study, 334 consecutive patients aged 70 years and older who underwent elective abdominal surgeries were included and observed for 12 months. For the non-oncologic group, the study included 219 consecutive patients aged 70 years and older, who were also observed for one year after the surgical procedure. Results: In the systematic review of the literature, CGA elements such as ADL, I-ADL, and GDS were used in 9 out of 10 studies, cognitive function assessment and medication intake assessment in 7 out of 10 studies, MNA in 6 out of 10 studies, CCI in 5 out of 10 studies, and BOMC and CDT in 1 out of 10 studies ; . However, scales assessing functional capacity and social support were not used in any of the studies. Functional assessment was shown to be a significant predictor of postoperative complications. Results for the other domains were too ambiguous to draw any clinical conclusions due to various methodological limitations. The prospective study of oncologic patients showed that all CGA elements were independent risk factors for complications within 30 days of the surgical procedure: ADL (OR 0.55-0.82; pO.OOl), I-ADL (OR 0.69-0.86; pO.OOl), MNA (OR 0.65- 0.79; pO.OOl), BOMC (OR 1.07-1.16;, pO.OOl), GDT (OR 0.49-0.67; pO.OOl), GDS (OR 1.25- 1.50; pO.OOl), TUG (OR 1.15-1.27; pO.OOl), CCS (OR 1.27-1.80; pO.OOl), MOSS (OR 0.91- 0.96; pO.OOl), medication intake (OR 1.07-1.31; pO.OOl). Similar results were observed for the 30- day postoperative mortality assessment: ADL (OR 0.51-0.87; p=0.002), 42 I-ADL (OR 0.63-0.88; pO.OOl), MNA (OR 0.61- 0.83; pO.OOl), BOMC (OR 0.99-1.14; p=0.06), GDT (OR 0.32-0.60; pO.OOl), GDS (OR 1.13- 1.50; pO.OOl), TUG (OR 1.22-1.49; pO.OOl), CCS (OR 1.58-2.80; pO.OOl), MOSS (OR 0.92- 0.98; pO.OOl), medication intake (OR 1.20-1.78; pO.OOl). Only ADL (OR 0.56-0.88; pO.OOl), CDT (OR 0.35-0.54; pO.OOl), and MOSS (OR 0.92-0.96, pO.OOl) were found to be useful in assessing the risk of 12-month mortality. Frailty syndrome was the most significant risk factor for posto ; perative complications.(OR 4.71-8.56; p<0.001). For patients eligible for laparoscopic cholecystectomy, no deaths were observed within 30 days of the operation. Complications were more frequently observed in the frailty syndrome group, but these were mainly medical rather than surgical complications. None of the CGA elements were found to be risk factors for complications in the short-term postoperative course. In contrast, in the long-term assessment, frailty syndrome was found to be a significant predictor of mortality within 12 months of the surgical procedure. Conclusions: The systematic review of existing literature showed that only the functional domain was a predictor of laparoscopic surgery complications in the elderly. Results for other domains were inconclusive due to various methodological limitations. All authors suggest that CGA and frailty syndrome should be mandatory elements of preoperative assessment in elderly adults. The analysis of our own population of oncologic patients showed that all CGA elements were independent risk factors for complications and mortality within 30 days of the surgical procedure. In the long term, only ADL, CDT, and MOSS scales were useful in assessing 12-month mortality risk. However, frailty syndrome was the most significant risk factor for both short- and long-term complications and mortality. Elective laparoscopic cholecystectomy i ; s a safe operation in the elderly population. Comprehensive Geriatric Assessment is not useful in assessing 43 short-term postoperative complication risk, but frailty syndrome diagnosed based on it is a significant predictor of long-term survival in this patient group.
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Rada Dyscypliny Nauki medyczne
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Jun 26, 2025
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Jun 26, 2025
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http://dl.cm-uj.krakow.pl:8080/publication/5266
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| Edition name | Date |
|---|---|
| ZB-143072 | Jun 26, 2025 |
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