Long‐Term Survival and Risk of Institutionalization in Onco‐Geriatric Surgical Patients: Long‐Term Results of the PREOP Study
OBJECTIVES To evaluate long‐term survival and institutionalization in onco‐geriatric surgical patients, and to analyze the association between these outcomes and a preoperative risk score. DESIGN Prospective cohort study with long‐term follow‐up. SETTING International and multicenter locations. PART...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2020-06, Vol.68 (6), p.1235-1241 |
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| creator | Huisman, Monique G. Ghignone, Federico Ugolini, Giampaolo Sidorenkov, Grigory Montroni, Isacco Vigano, Antonio Liguori Carino, Nicola Farinella, Eriberto Cirocchi, Roberto Audisio, Riccardo A. Bock, Geertruida H. Leeuwen, Barbara L. |
| description | OBJECTIVES
To evaluate long‐term survival and institutionalization in onco‐geriatric surgical patients, and to analyze the association between these outcomes and a preoperative risk score.
DESIGN
Prospective cohort study with long‐term follow‐up.
SETTING
International and multicenter locations.
PARTICIPANTS
Patients aged 70 years or older undergoing elective surgery for a malignant solid tumor at five centers (n = 229).
MEASUREMENTS
We assessed long‐term survival and institutionalization using the Preoperative Risk Estimation for Onco‐geriatric Patients (PREOP) score, developed to predict the 30‐day risk of major complications. The PREOP score collected data about sex, type of surgery, and the American Society for Anesthesiologists classification, as well as the Timed Up & Go test and the Nutritional Risk Screening results. An overall score higher than 8 was considered abnormal.
RESULTS
We included 149 women and 80 men (median age = 76 y; interquartile range = 8). Survival at 1, 2, and 5 years postoperatively was 84%, 77%, and 56%, respectively. Moreover, survival at 1 year was worse for patients with a PREOP risk score higher than 8 (70%) compared with 8 or lower (91%). Of those alive at 1 year, 43 (26%) were institutionalized, and by 2 years, almost half of the entire cohort (46%) were institutionalized or had died. A PREOP risk score higher than 8 was associated with increased mortality (hazard ratio = 2.6; 95% confidence interval [CI] = 1.7‐4.0), irrespective of stage and age, but not with being institutionalized (odds ratios = 1 y, 1.6 [95% CI = .7‐3.8]; 2 y, 2.2 [95% CI = .9‐5.5]).
CONCLUSION
A high PREOP score is associated with mortality but not with remaining independent. Despite acceptable survival rates, physical function may deteriorate after surgery. It is imperative to discuss treatment goals and expectations preoperatively to determine if they are feasible. Using the PREOP risk score can provide an objective measure on which to base decisions. J Am Geriatr Soc 68:1235–1241, 2020. |
| doi_str_mv | 10.1111/jgs.16384 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7318670</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2376225911</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4434-4b08ca3ea5009c73e8ac659b1f04abdb796acbdaaed14f1141095c3168267a483</originalsourceid><addsrcrecordid>eNp1kc1uEzEURi0EoqGw4AWQJTawmNbXPzMeFkioKqEoUqKkrC2Px5M6TMatPRMUVki8AM_Ik-AhpSpIeGNLPvfo0_0Qeg7kBNI53azjCeRM8gdoAoLRTHAQD9GEEEIzmQM_Qk9i3BAClEj5GB0xCkJQWU7Q95nv1j-__bi0YYtXQ9i5nW6x7mq8dPEz9g2-6GLv-qF3vtOt-6rHB3YdnnfGp8GpDU73wZlxeu1Mml4kxnZ9fIPvy5c2Dm0fR2V_ZfFieT5f4FU_1Pun6FGj22if3d7H6NP788uzD9lsPr04ezfLDOeMZ7wi0mhmtSCkNAWzUptclBU0hOuqrooy16aqtbY18AaAAymFYZBLmheaS3aM3h6810O1tbVJGYNu1XVwWx32ymun_v7p3JVa-50qGMi8IEnw6lYQ_M1gY6-2LhrbtrqzfoiKsiKnVJQACX35D7rxQ0gbTBQHWuSCwJjo9YEywccYbHMXBogaq1WpWvW72sS-uJ_-jvzTZQJOD8AX19r9_03q43R1UP4Cz-WyQw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2412765018</pqid></control><display><type>article</type><title>Long‐Term Survival and Risk of Institutionalization in Onco‐Geriatric Surgical Patients: Long‐Term Results of the PREOP Study</title><source>Wiley-Blackwell Journals</source><source>MEDLINE</source><creator>Huisman, Monique G. ; Ghignone, Federico ; Ugolini, Giampaolo ; Sidorenkov, Grigory ; Montroni, Isacco ; Vigano, Antonio ; Liguori Carino, Nicola ; Farinella, Eriberto ; Cirocchi, Roberto ; Audisio, Riccardo A. ; Bock, Geertruida H. ; Leeuwen, Barbara L.</creator><creatorcontrib>Huisman, Monique G. ; Ghignone, Federico ; Ugolini, Giampaolo ; Sidorenkov, Grigory ; Montroni, Isacco ; Vigano, Antonio ; Liguori Carino, Nicola ; Farinella, Eriberto ; Cirocchi, Roberto ; Audisio, Riccardo A. ; Bock, Geertruida H. ; Leeuwen, Barbara L.</creatorcontrib><description>OBJECTIVES
To evaluate long‐term survival and institutionalization in onco‐geriatric surgical patients, and to analyze the association between these outcomes and a preoperative risk score.
DESIGN
Prospective cohort study with long‐term follow‐up.
SETTING
International and multicenter locations.
PARTICIPANTS
Patients aged 70 years or older undergoing elective surgery for a malignant solid tumor at five centers (n = 229).
MEASUREMENTS
We assessed long‐term survival and institutionalization using the Preoperative Risk Estimation for Onco‐geriatric Patients (PREOP) score, developed to predict the 30‐day risk of major complications. The PREOP score collected data about sex, type of surgery, and the American Society for Anesthesiologists classification, as well as the Timed Up & Go test and the Nutritional Risk Screening results. An overall score higher than 8 was considered abnormal.
RESULTS
We included 149 women and 80 men (median age = 76 y; interquartile range = 8). Survival at 1, 2, and 5 years postoperatively was 84%, 77%, and 56%, respectively. Moreover, survival at 1 year was worse for patients with a PREOP risk score higher than 8 (70%) compared with 8 or lower (91%). Of those alive at 1 year, 43 (26%) were institutionalized, and by 2 years, almost half of the entire cohort (46%) were institutionalized or had died. A PREOP risk score higher than 8 was associated with increased mortality (hazard ratio = 2.6; 95% confidence interval [CI] = 1.7‐4.0), irrespective of stage and age, but not with being institutionalized (odds ratios = 1 y, 1.6 [95% CI = .7‐3.8]; 2 y, 2.2 [95% CI = .9‐5.5]).
CONCLUSION
A high PREOP score is associated with mortality but not with remaining independent. Despite acceptable survival rates, physical function may deteriorate after surgery. It is imperative to discuss treatment goals and expectations preoperatively to determine if they are feasible. Using the PREOP risk score can provide an objective measure on which to base decisions. J Am Geriatr Soc 68:1235–1241, 2020.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.16384</identifier><identifier>PMID: 32155289</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Aged ; Aged, 80 and over ; Clinical Investigation ; Elective Surgical Procedures - mortality ; Female ; Geriatric Assessment ; Geriatrics ; Humans ; Institutionalization ; Institutionalization - statistics & numerical data ; Longitudinal Studies ; Male ; Mortality ; Neoplasms - mortality ; Neoplasms - surgery ; onco‐geriatric patients ; Patients ; Postoperative Complications - diagnosis ; postoperative outcome ; Prospective Studies ; Regular Issue Content ; Risk Assessment ; Solid tumors ; Surgery ; Survival ; Survival Rate - trends ; Time Factors</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2020-06, Vol.68 (6), p.1235-1241</ispartof><rights>2020 The Authors. published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.</rights><rights>2020 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.</rights><rights>2020. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4434-4b08ca3ea5009c73e8ac659b1f04abdb796acbdaaed14f1141095c3168267a483</citedby><cites>FETCH-LOGICAL-c4434-4b08ca3ea5009c73e8ac659b1f04abdb796acbdaaed14f1141095c3168267a483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.16384$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.16384$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32155289$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huisman, Monique G.</creatorcontrib><creatorcontrib>Ghignone, Federico</creatorcontrib><creatorcontrib>Ugolini, Giampaolo</creatorcontrib><creatorcontrib>Sidorenkov, Grigory</creatorcontrib><creatorcontrib>Montroni, Isacco</creatorcontrib><creatorcontrib>Vigano, Antonio</creatorcontrib><creatorcontrib>Liguori Carino, Nicola</creatorcontrib><creatorcontrib>Farinella, Eriberto</creatorcontrib><creatorcontrib>Cirocchi, Roberto</creatorcontrib><creatorcontrib>Audisio, Riccardo A.</creatorcontrib><creatorcontrib>Bock, Geertruida H.</creatorcontrib><creatorcontrib>Leeuwen, Barbara L.</creatorcontrib><title>Long‐Term Survival and Risk of Institutionalization in Onco‐Geriatric Surgical Patients: Long‐Term Results of the PREOP Study</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>OBJECTIVES
To evaluate long‐term survival and institutionalization in onco‐geriatric surgical patients, and to analyze the association between these outcomes and a preoperative risk score.
DESIGN
Prospective cohort study with long‐term follow‐up.
SETTING
International and multicenter locations.
PARTICIPANTS
Patients aged 70 years or older undergoing elective surgery for a malignant solid tumor at five centers (n = 229).
MEASUREMENTS
We assessed long‐term survival and institutionalization using the Preoperative Risk Estimation for Onco‐geriatric Patients (PREOP) score, developed to predict the 30‐day risk of major complications. The PREOP score collected data about sex, type of surgery, and the American Society for Anesthesiologists classification, as well as the Timed Up & Go test and the Nutritional Risk Screening results. An overall score higher than 8 was considered abnormal.
RESULTS
We included 149 women and 80 men (median age = 76 y; interquartile range = 8). Survival at 1, 2, and 5 years postoperatively was 84%, 77%, and 56%, respectively. Moreover, survival at 1 year was worse for patients with a PREOP risk score higher than 8 (70%) compared with 8 or lower (91%). Of those alive at 1 year, 43 (26%) were institutionalized, and by 2 years, almost half of the entire cohort (46%) were institutionalized or had died. A PREOP risk score higher than 8 was associated with increased mortality (hazard ratio = 2.6; 95% confidence interval [CI] = 1.7‐4.0), irrespective of stage and age, but not with being institutionalized (odds ratios = 1 y, 1.6 [95% CI = .7‐3.8]; 2 y, 2.2 [95% CI = .9‐5.5]).
CONCLUSION
A high PREOP score is associated with mortality but not with remaining independent. Despite acceptable survival rates, physical function may deteriorate after surgery. It is imperative to discuss treatment goals and expectations preoperatively to determine if they are feasible. Using the PREOP risk score can provide an objective measure on which to base decisions. J Am Geriatr Soc 68:1235–1241, 2020.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Clinical Investigation</subject><subject>Elective Surgical Procedures - mortality</subject><subject>Female</subject><subject>Geriatric Assessment</subject><subject>Geriatrics</subject><subject>Humans</subject><subject>Institutionalization</subject><subject>Institutionalization - statistics & numerical data</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Mortality</subject><subject>Neoplasms - mortality</subject><subject>Neoplasms - surgery</subject><subject>onco‐geriatric patients</subject><subject>Patients</subject><subject>Postoperative Complications - diagnosis</subject><subject>postoperative outcome</subject><subject>Prospective Studies</subject><subject>Regular Issue Content</subject><subject>Risk Assessment</subject><subject>Solid tumors</subject><subject>Surgery</subject><subject>Survival</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kc1uEzEURi0EoqGw4AWQJTawmNbXPzMeFkioKqEoUqKkrC2Px5M6TMatPRMUVki8AM_Ik-AhpSpIeGNLPvfo0_0Qeg7kBNI53azjCeRM8gdoAoLRTHAQD9GEEEIzmQM_Qk9i3BAClEj5GB0xCkJQWU7Q95nv1j-__bi0YYtXQ9i5nW6x7mq8dPEz9g2-6GLv-qF3vtOt-6rHB3YdnnfGp8GpDU73wZlxeu1Mml4kxnZ9fIPvy5c2Dm0fR2V_ZfFieT5f4FU_1Pun6FGj22if3d7H6NP788uzD9lsPr04ezfLDOeMZ7wi0mhmtSCkNAWzUptclBU0hOuqrooy16aqtbY18AaAAymFYZBLmheaS3aM3h6810O1tbVJGYNu1XVwWx32ymun_v7p3JVa-50qGMi8IEnw6lYQ_M1gY6-2LhrbtrqzfoiKsiKnVJQACX35D7rxQ0gbTBQHWuSCwJjo9YEywccYbHMXBogaq1WpWvW72sS-uJ_-jvzTZQJOD8AX19r9_03q43R1UP4Cz-WyQw</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Huisman, Monique G.</creator><creator>Ghignone, Federico</creator><creator>Ugolini, Giampaolo</creator><creator>Sidorenkov, Grigory</creator><creator>Montroni, Isacco</creator><creator>Vigano, Antonio</creator><creator>Liguori Carino, Nicola</creator><creator>Farinella, Eriberto</creator><creator>Cirocchi, Roberto</creator><creator>Audisio, Riccardo A.</creator><creator>Bock, Geertruida H.</creator><creator>Leeuwen, Barbara L.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202006</creationdate><title>Long‐Term Survival and Risk of Institutionalization in Onco‐Geriatric Surgical Patients: Long‐Term Results of the PREOP Study</title><author>Huisman, Monique G. ; Ghignone, Federico ; Ugolini, Giampaolo ; Sidorenkov, Grigory ; Montroni, Isacco ; Vigano, Antonio ; Liguori Carino, Nicola ; Farinella, Eriberto ; Cirocchi, Roberto ; Audisio, Riccardo A. ; Bock, Geertruida H. ; Leeuwen, Barbara L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4434-4b08ca3ea5009c73e8ac659b1f04abdb796acbdaaed14f1141095c3168267a483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Clinical Investigation</topic><topic>Elective Surgical Procedures - mortality</topic><topic>Female</topic><topic>Geriatric Assessment</topic><topic>Geriatrics</topic><topic>Humans</topic><topic>Institutionalization</topic><topic>Institutionalization - statistics & numerical data</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Mortality</topic><topic>Neoplasms - mortality</topic><topic>Neoplasms - surgery</topic><topic>onco‐geriatric patients</topic><topic>Patients</topic><topic>Postoperative Complications - diagnosis</topic><topic>postoperative outcome</topic><topic>Prospective Studies</topic><topic>Regular Issue Content</topic><topic>Risk Assessment</topic><topic>Solid tumors</topic><topic>Surgery</topic><topic>Survival</topic><topic>Survival Rate - trends</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huisman, Monique G.</creatorcontrib><creatorcontrib>Ghignone, Federico</creatorcontrib><creatorcontrib>Ugolini, Giampaolo</creatorcontrib><creatorcontrib>Sidorenkov, Grigory</creatorcontrib><creatorcontrib>Montroni, Isacco</creatorcontrib><creatorcontrib>Vigano, Antonio</creatorcontrib><creatorcontrib>Liguori Carino, Nicola</creatorcontrib><creatorcontrib>Farinella, Eriberto</creatorcontrib><creatorcontrib>Cirocchi, Roberto</creatorcontrib><creatorcontrib>Audisio, Riccardo A.</creatorcontrib><creatorcontrib>Bock, Geertruida H.</creatorcontrib><creatorcontrib>Leeuwen, Barbara L.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huisman, Monique G.</au><au>Ghignone, Federico</au><au>Ugolini, Giampaolo</au><au>Sidorenkov, Grigory</au><au>Montroni, Isacco</au><au>Vigano, Antonio</au><au>Liguori Carino, Nicola</au><au>Farinella, Eriberto</au><au>Cirocchi, Roberto</au><au>Audisio, Riccardo A.</au><au>Bock, Geertruida H.</au><au>Leeuwen, Barbara L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long‐Term Survival and Risk of Institutionalization in Onco‐Geriatric Surgical Patients: Long‐Term Results of the PREOP Study</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2020-06</date><risdate>2020</risdate><volume>68</volume><issue>6</issue><spage>1235</spage><epage>1241</epage><pages>1235-1241</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract>OBJECTIVES
To evaluate long‐term survival and institutionalization in onco‐geriatric surgical patients, and to analyze the association between these outcomes and a preoperative risk score.
DESIGN
Prospective cohort study with long‐term follow‐up.
SETTING
International and multicenter locations.
PARTICIPANTS
Patients aged 70 years or older undergoing elective surgery for a malignant solid tumor at five centers (n = 229).
MEASUREMENTS
We assessed long‐term survival and institutionalization using the Preoperative Risk Estimation for Onco‐geriatric Patients (PREOP) score, developed to predict the 30‐day risk of major complications. The PREOP score collected data about sex, type of surgery, and the American Society for Anesthesiologists classification, as well as the Timed Up & Go test and the Nutritional Risk Screening results. An overall score higher than 8 was considered abnormal.
RESULTS
We included 149 women and 80 men (median age = 76 y; interquartile range = 8). Survival at 1, 2, and 5 years postoperatively was 84%, 77%, and 56%, respectively. Moreover, survival at 1 year was worse for patients with a PREOP risk score higher than 8 (70%) compared with 8 or lower (91%). Of those alive at 1 year, 43 (26%) were institutionalized, and by 2 years, almost half of the entire cohort (46%) were institutionalized or had died. A PREOP risk score higher than 8 was associated with increased mortality (hazard ratio = 2.6; 95% confidence interval [CI] = 1.7‐4.0), irrespective of stage and age, but not with being institutionalized (odds ratios = 1 y, 1.6 [95% CI = .7‐3.8]; 2 y, 2.2 [95% CI = .9‐5.5]).
CONCLUSION
A high PREOP score is associated with mortality but not with remaining independent. Despite acceptable survival rates, physical function may deteriorate after surgery. It is imperative to discuss treatment goals and expectations preoperatively to determine if they are feasible. Using the PREOP risk score can provide an objective measure on which to base decisions. J Am Geriatr Soc 68:1235–1241, 2020.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>32155289</pmid><doi>10.1111/jgs.16384</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Clinical Investigation Elective Surgical Procedures - mortality Female Geriatric Assessment Geriatrics Humans Institutionalization Institutionalization - statistics & numerical data Longitudinal Studies Male Mortality Neoplasms - mortality Neoplasms - surgery onco‐geriatric patients Patients Postoperative Complications - diagnosis postoperative outcome Prospective Studies Regular Issue Content Risk Assessment Solid tumors Surgery Survival Survival Rate - trends Time Factors |
| title | Long‐Term Survival and Risk of Institutionalization in Onco‐Geriatric Surgical Patients: Long‐Term Results of the PREOP Study |
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