Preoperative Geriatric Assessment and Tailored Interventions in Frail Older Patients With Colorectal Cancer: A Randomized Controlled Trial

Colorectal Dis. 2018 Jan;20(1):16-25. doi: 10.1111/codi.13785.

Abstract

Aim: Colorectal cancer (CRC) is prevalent in the older population, and surgery is the mainstay of curative treatment. A preoperative geriatric assessment (GA) can identify frail older patients at risk for developing postoperative complications. In this randomized controlled trial we wanted to investigate whether tailored interventions based on a preoperative GA could reduce the frequency of postoperative complications in frail patients operated on for CRC.

Method: Patients > 65 years scheduled for elective CRC surgery and fulfilling predefined criteria for frailty were randomized to either a preoperative GA followed by a tailored intervention or care as usual. The primary end-point was Clavien-Dindo Grade II-V postoperative complications. Secondary end-points included complications of any grade, reoperation, length of stay, readmission and survival.

Results: One hundred and twenty-two patients with a mean age of 78.6 years were randomized. We found no statistically significant differences between the intervention group and the control group for Grade II-V complications (68% vs 75%, P = 0.43), reoperation (19% vs 11%, P = 0.24), length of stay (8 days in both groups), readmission (16% vs 6%, P = 0.12) or 30-day survival (4% vs 5%, P = 0.79). Grade I-V complications occurred in 76% of patients in the intervention group compared with 87% in the control group (P = 0.10). In secondary analyses adjusting for prespecified prognostic factors, there was a statistically significant difference in favour of the intervention for reducing the total number of Grade I-V complications (P = 0.05).

Conclusion: A preoperative GA and tailored interventions did not reduce the rate of Grade II-V complications, reoperations, readmission or mortality in frail older patients electively operated on for CRC.

Keywords: Geriatric assessment; colorectal cancer; frail elderly; postoperative complications.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Colorectal Neoplasms / surgery*
  • Female
  • Frail Elderly
  • Geriatric Assessment / methods*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Norway
  • Outcome Assessment, Health Care
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Preoperative Care / adverse effects
  • Preoperative Care / methods*
  • Reoperation / statistics & numerical data
  • Risk Assessment / methods*
  • Risk Factors
  • Single-Blind Method
  • Survival Rate