In the Journals

Geriatric events increase morbidity, costs among older patients who undergo cancer surgery

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May 24, 2016

Older individuals who underwent cancer surgery appeared likely to experience geriatric events, such as falls and fractures, delirium and dehydration.

These events — incidence of which increased with age — often resulted in operative morbidity, prolonged hospitalization or more expensive health care, results showed.

Adults aged 65 years or older account for more than half of new cancer cases in the United States. Therefore, age-related health conditions — such as functional decline, cognitive disorders, frailty, comorbidities, malnutrition and polypharmacy — are becoming an increasing concern.

“These events affect approximately one in 10 patients over the age of 54 undergoing cancer surgery in the United States,” Hung-Jui Tan, MD, a fellow in urologic oncology at the University of California, said in a press release. “With even higher rates observed among the very old, patients 75 and older — the fastest-growing segment of the population — geriatric events during cancer-related surgery are likely to become even more prevalent.”

Tan and colleagues used Nationwide Inpatient Sample data from 2009 to 2011 to calculate hospital admissions for major cancer surgery among patients 65 years or older and a referent group of patients aged 55 to 64 years old. They focused on admissions for the 10 most common solid-organ malignancies.

Researchers compared incidence of dehydration, delirium, falls and fractures, failure to thrive and pressure ulcers after surgery.

The analysis included a weighted sample of 939,150 patients aged 55 years or older admitted for major cancer surgery. From this group, 9.2% (95% CI, 8.8-9.7) experienced at least one geriatric event during hospitalization.

Nearly half (45.6%) of patients aged 75 years or older experienced any geriatric event, compared with 32.3% of those aged 65 to 74 years, and 22.1% of those aged 55 to 64 years.

After adjusting for patient and hospital characteristics, researchers found patients aged 75 years and older had a 65.7% higher probability than those aged 55 to 64 years to experience a geriatric event. Patients aged 65 to 74 years had a 22.9% higher probability than those aged 55 to 64 to experience a geriatric event.

Patients with Charlson comorbidity scores of 2 or higher appeared more likely to experience any geriatric event (56.8%) than those with scores of 0 (24%) or 1 (19.2%).

Geriatric events were most common among patients who underwent surgery for cancer of the stomach (25.5%), pancreas (25.2%), colon and/or rectum (16.6%), bladder (15.3%) or ovary (14.4%).

“The findings highlight the importance for older patients to discuss these potential events with their doctors as they prepare for surgery,” Tan said in the press release. “Now that the prevalence of such events is known, treatment approaches that keep these age-related health concerns in mind may be better applied in the future to better assist these patients.”

Patients who experienced a geriatric event appeared more likely to develop a concurrent inpatient complication (OR = 3.73; 95% CI, 3.55-3.92), experience prolonged hospitalization (OR = 5.47; 95% CI, 5.16-5.8), incur high costs (OR = 4.97; 95% CI, 4.58-5.39), experience inpatient mortality (OR = 3.22; 95% CI, 2.94-3.53) or have a discharge disposition other than home (OR = 3.64; 95% CI, 3.46-3.84).

“These events may add to operative morbidity and resource utilization, straining both patients and the cancer care delivery system,” Tan and colleagues wrote. “Efforts aimed at addressing older age-related health concerns and reducing associated morbidity will be essential as the number of older adults with cancer continues to grow.” – by Kristie L. Kahl

Disclosure: The researchers report no relevant financial disclosures.

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