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Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer

IMPORTANCE: Collaboration between geriatricians and surgeons in the perioperative treatment of older patients has been associated with improved outcomes in several nononcologic specialties. Similar associations may be possible among older patients with cancer. OBJECTIVE: To investigate the associati...

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Autores principales: Shahrokni, Armin, Tin, Amy L., Sarraf, Saman, Alexander, Koshy, Sun, Steve, Kim, Soo Jung, McMillan, Sincere, Yulico, Heidi, Amirnia, Farnia, Downey, Robert J., Vickers, Andrew J., Korc-Grodzicki, Beatriz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439108/
https://www.ncbi.nlm.nih.gov/pubmed/32822490
http://dx.doi.org/10.1001/jamanetworkopen.2020.9265
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author Shahrokni, Armin
Tin, Amy L.
Sarraf, Saman
Alexander, Koshy
Sun, Steve
Kim, Soo Jung
McMillan, Sincere
Yulico, Heidi
Amirnia, Farnia
Downey, Robert J.
Vickers, Andrew J.
Korc-Grodzicki, Beatriz
author_facet Shahrokni, Armin
Tin, Amy L.
Sarraf, Saman
Alexander, Koshy
Sun, Steve
Kim, Soo Jung
McMillan, Sincere
Yulico, Heidi
Amirnia, Farnia
Downey, Robert J.
Vickers, Andrew J.
Korc-Grodzicki, Beatriz
author_sort Shahrokni, Armin
collection PubMed
description IMPORTANCE: Collaboration between geriatricians and surgeons in the perioperative treatment of older patients has been associated with improved outcomes in several nononcologic specialties. Similar associations may be possible among older patients with cancer. OBJECTIVE: To investigate the associations of geriatric comanagement of care for older patients undergoing cancer-related surgical treatment with 90-day postoperative mortality, rate of adverse surgical events, and postoperative use of inpatient supportive care services. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study assessed outcomes of patients who received geriatric comanaged care vs those who did not using multivariable logistic regression analysis, with 90-day mortality as the outcome and geriatric comanagement of care as the main variable, with adjustment for age, sex, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index score, preoperative albumin level, operative time, and estimated blood loss. A similar model was used to assess the association of geriatric comanagement with adverse surgical events, defined as any major complication, readmission, or emergency department visit within 30 days. Patients aged 75 years and older who underwent an elective surgical procedure with a hospital stay of at least 1 day at a single tertiary-care cancer center between February 2015 and February 2018 were included. Data were analyzed from January to July 2019. EXPOSURES: Postoperative care comanaged by the geriatrics service and surgical service (geriatric comanagement group) vs by the surgical service only (surgical service group). MAIN OUTCOMES AND MEASURES: 90-day mortality, adverse surgical events, and use of supportive care services. RESULTS: Of 1892 patients included, 1020 (53.9%) received geriatric comanagement of care; these patients, compared with those who received care managed by the surgery service only, were older (mean [SD] age, 81 [4] years vs 80 [4] years; P < .001), had longer operative time (mean [SD], 203 [146] minutes vs 138 [112] minutes; P < .001), and longer length of stay (median [interquartile range], 5 [3-8] days vs 4 [2-7] days; P < .001). There were no differences in the proportions of men (488 [47.8%] men vs 450 [51.6%] men; P = .11). Adverse surgical events were not significantly different between groups (odds ratio, 0.93 [95% CI, 0.73-1.18]; P = .54). However, the adjusted probability of death within 90 days after surgical treatment was 4.3% for the geriatric comanagement group vs 8.9% for the surgical service group (difference, 4.6% [95% CI, 2.3%-6.9%]; P < .001). Additionally, compared with patients who received postoperative care management from the surgery service only, a higher proportion of patients in the geriatric comanagement group received inpatient supportive care services, including physical therapy (555 patients [63.6%] vs 820 patients [80.4%]; P < .001), occupational therapy (220 patients [25.2%] vs 385 patients [37.7%]; P < .001), speech and swallow rehabilitation (42 patients [4.8%] vs 86 patients [8.4%]; P = .002), and nutrition services (637 patients [73.1%] vs 803 patients [78.7%]; P = .004). CONCLUSIONS AND RELEVANCE: This cohort study found that geriatric comanagement was associated with significantly lower 90-day postoperative mortality among older patients with cancer. These findings suggest that such patients may benefit from geriatric comanagement, which could improve their ability to survive adverse postoperative events.
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spelling pubmed-74391082020-08-24 Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer Shahrokni, Armin Tin, Amy L. Sarraf, Saman Alexander, Koshy Sun, Steve Kim, Soo Jung McMillan, Sincere Yulico, Heidi Amirnia, Farnia Downey, Robert J. Vickers, Andrew J. Korc-Grodzicki, Beatriz JAMA Netw Open Original Investigation IMPORTANCE: Collaboration between geriatricians and surgeons in the perioperative treatment of older patients has been associated with improved outcomes in several nononcologic specialties. Similar associations may be possible among older patients with cancer. OBJECTIVE: To investigate the associations of geriatric comanagement of care for older patients undergoing cancer-related surgical treatment with 90-day postoperative mortality, rate of adverse surgical events, and postoperative use of inpatient supportive care services. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study assessed outcomes of patients who received geriatric comanaged care vs those who did not using multivariable logistic regression analysis, with 90-day mortality as the outcome and geriatric comanagement of care as the main variable, with adjustment for age, sex, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index score, preoperative albumin level, operative time, and estimated blood loss. A similar model was used to assess the association of geriatric comanagement with adverse surgical events, defined as any major complication, readmission, or emergency department visit within 30 days. Patients aged 75 years and older who underwent an elective surgical procedure with a hospital stay of at least 1 day at a single tertiary-care cancer center between February 2015 and February 2018 were included. Data were analyzed from January to July 2019. EXPOSURES: Postoperative care comanaged by the geriatrics service and surgical service (geriatric comanagement group) vs by the surgical service only (surgical service group). MAIN OUTCOMES AND MEASURES: 90-day mortality, adverse surgical events, and use of supportive care services. RESULTS: Of 1892 patients included, 1020 (53.9%) received geriatric comanagement of care; these patients, compared with those who received care managed by the surgery service only, were older (mean [SD] age, 81 [4] years vs 80 [4] years; P < .001), had longer operative time (mean [SD], 203 [146] minutes vs 138 [112] minutes; P < .001), and longer length of stay (median [interquartile range], 5 [3-8] days vs 4 [2-7] days; P < .001). There were no differences in the proportions of men (488 [47.8%] men vs 450 [51.6%] men; P = .11). Adverse surgical events were not significantly different between groups (odds ratio, 0.93 [95% CI, 0.73-1.18]; P = .54). However, the adjusted probability of death within 90 days after surgical treatment was 4.3% for the geriatric comanagement group vs 8.9% for the surgical service group (difference, 4.6% [95% CI, 2.3%-6.9%]; P < .001). Additionally, compared with patients who received postoperative care management from the surgery service only, a higher proportion of patients in the geriatric comanagement group received inpatient supportive care services, including physical therapy (555 patients [63.6%] vs 820 patients [80.4%]; P < .001), occupational therapy (220 patients [25.2%] vs 385 patients [37.7%]; P < .001), speech and swallow rehabilitation (42 patients [4.8%] vs 86 patients [8.4%]; P = .002), and nutrition services (637 patients [73.1%] vs 803 patients [78.7%]; P = .004). CONCLUSIONS AND RELEVANCE: This cohort study found that geriatric comanagement was associated with significantly lower 90-day postoperative mortality among older patients with cancer. These findings suggest that such patients may benefit from geriatric comanagement, which could improve their ability to survive adverse postoperative events. American Medical Association 2020-08-19 /pmc/articles/PMC7439108/ /pubmed/32822490 http://dx.doi.org/10.1001/jamanetworkopen.2020.9265 Text en Copyright 2020 Shahrokni A et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Shahrokni, Armin
Tin, Amy L.
Sarraf, Saman
Alexander, Koshy
Sun, Steve
Kim, Soo Jung
McMillan, Sincere
Yulico, Heidi
Amirnia, Farnia
Downey, Robert J.
Vickers, Andrew J.
Korc-Grodzicki, Beatriz
Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer
title Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer
title_full Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer
title_fullStr Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer
title_full_unstemmed Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer
title_short Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer
title_sort association of geriatric comanagement and 90-day postoperative mortality among patients aged 75 years and older with cancer
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439108/
https://www.ncbi.nlm.nih.gov/pubmed/32822490
http://dx.doi.org/10.1001/jamanetworkopen.2020.9265
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