Does Preoperative Comprehensive Geriatric Assessment and Frailty Predict Postoperative Complications?

• DOI: 10.1007/s00268-020-05715-8
• Publication Date: 2020-07-31T13:05:04Z
• Authors: Rana Tuna Dogrul; Ahmet Bulent Dogrul; Ali Konan; Omur Caglar; Fatih Sumer; Hatice Caliskan; Muhammet Cemal Ki...; Mustafa Kemal Kilic; Cafer Balci; Gunes Arik; Gozde Sengul Aycicek; Cemile Ozsurekci; Meltem Halil; Mustafa Cankurtaran; Burcu Balam Yavuz
• Keywords: Geriatric Depression Scale; Vascular surgery; Depression; Charlson comorbidity index

AbstractBackgroundThe influence of preoperative comprehensive geriatric assessment and frailty on postoperative morbidity, mortality, delirium were examined.MethodsA total of 108 patients were evaluated. The Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Brody Instrumental Activities of Daily Living Scale (IADL), the Mini‐Nutrition Assessment test (MNA), the Mini‐Mental State Examination (MMSE), Yesavage Geriatric Depression Scale (GDS) were performed. Fried Criteria were used to assess physical frailty. We used the Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity score (POSSUM), the American Society of Anesthesiologists Score (ASA), and the Charlson Comorbidity Index (CCI) to determine the risk of postoperative morbidity and mortality. Assessment Test for Delirium (4AT) was applied for detection of delirium.ResultsThe median age was 71 years (min–max: 65–84). IADL (p = 0.032), MNA (p = 0.01), MMSE scores (p = 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p = 0.005), operative score (p = 0.015) and CCI (p = 0.029) were significantly higher in the patients with morbidity. Patients developed morbidity were found to be more frail (p < 0.001). The patients with delirium were found to have lower IADL (p = 0.049) and MMSE scores (p = 0.004), higher POSSUM physiology score (p = 0.005) and all of them were frail. It was found that frailty (OR = 23.695 95% CI: 6.912–81.231 p < 0.001), POSSUM operative score (OR:1.118 95% CI: 1.021–1.224 p = 0.016) and preoperative systolic blood pressure (OR:0.937%95 CI: 0.879–0.999 p = 0.048) were independently related factors for postoperative morbidity.ConclusionIn our study, CGA and frailty in preoperative period were found to be indicators for postoperative morbidity and delirium.