85: Impact of Incident Hospital-Acquired Geriatric Syndromes on Short-term Outcomes following Gastrointestinal Cancer Resection

Saturday, March 25, 2023

9:56 AM – 10:06 AM

Location: Ballroom B

Abstract Presenter(s)

Alexa D. Melucci, MD, MS (she/her/hers)

Resident
University of Rochester Medical Center
Rochester, New York, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Alexa D. Melucci, MD, MS (she/her/hers)

Resident
University of Rochester Medical Center
Rochester, New York, United States

Disclosure(s): No financial relationships to disclose

Author(s)

Christopher T. Aquina, MD, MPH

Assistant Professor
AdventHealth Orlando
Orlando, Florida, United States

Disclosure information not submitted.
AL

Anthony Loria, MD

Resident
University of Rochester Medical Center, United States

Disclosure information not submitted.
GM

Gabriela McDonald, BS

Medical Student
University of Rochester Medical Center, United States

Disclosure information not submitted.
AG

Aqsa Ghaffar, BA

Medical Student
University of Rochester Medical Center, United States

Disclosure information not submitted.
ER

Erika Ramsdale, MD

Associate Professor Department of Medicine
University of Rochester Medical Center, United States

Disclosure information not submitted.
Larissa Temple, MSc MD (she/her/hers)

Chief Colorectal Surgery, Professor Surgery and Oncology
University of Rochester, New York New York
Rochester, New York, United States

Disclosure information not submitted.
Fergal J. Fleming, MD, MPH, FRCSI, FACS

Associate Professor Department of Surgery
University of Rochester Medical Center, United States

Disclosure information not submitted.

Disclosure(s):

Alexa D. Melucci, MD, MS: No financial relationships to disclose

Introduction: Geriatric syndromes (GS) are conditions that disproportionately affect older adults and are associated with increased healthcare utilization, cost, and mortality. The extent oncologic resection precipitates the development of hospital-acquired GS and influences outcomes is unclear. Therefore, we assessed incident hospital-acquired GS and determined their association with outcomes.

Methods: Patients aged >55 who underwent resection of stage I-III esophageal, gastric, pancreatic, or colorectal cancer between 2004-2017 were identified in the New York State Cancer Registry and Statewide Planning and Research Cooperative System. The exposure was incident hospital-acquired GS following oncologic resection. A 12-month lookback was performed to ensure no history of a GS, which included any of the following: delirium, depression, incontinence, malnutrition, failure to thrive, dehydration, pressure ulcer, fracture, or falls. Multivariable analyses assessed the association between GS and the postoperative outcomes including mortality, morbidity, length of stay, non-home discharge, and readmission.

Results: Of the 47,081 eligible patients, 38,904 (82.6%) had no history of a GS 12 months before resection. Among these, 6.1% had an incident hospital-acquired GS. Patients who developed an incident GS were significantly older (median age 74 vs. 71), more likely to receive neoadjuvant therapy (80.8% vs. 79.2%) and undergo resection for upper GI cancer (33.3% vs. 19.1%). After risk adjustment, increasing age, male sex, current smoking and alcohol use, comorbidities, neoadjuvant therapy, upper GI resection, and ostomy formation were associated with increased odds of an incident GS (Figure 1). An incident GS was associated with decreased odds of 30-day readmission (OR 0.84; 95% CI, 0.74-0.96), but prolonged length of stay (OR 4.25; 95% CI, 3.79-4.77), increased odds of inpatient mortality (OR 2.98; 95% CI, 2.40-3.69), 30-day mortality (OR 2.50; 95% CI, 2.09-3.00), postoperative morbidity (OR 3.28; 95% CI, 2.95-3.64), and non-home discharge (OR 3.08; 95% CI, 2.63-3.62) compared to those who did not develop a GS.

Conclusions: Older adults who develop an incident GS following GI oncologic resections have higher odds of postoperative mortality, morbidity, and healthcare utilization. Given that a comprehensive geriatric assessment (CGA) is associated with improved outcomes and can identify risk factors associated with a GS, a preoperative CGA may identify patients who may benefit from geriatrician co-management.

Learning Objectives:

Upon completion, participant will be able to describe the incidence of developing a hospital-acquired geriatric syndrome in patients after oncologic resection for stage I-III gastrointestinal cancer.
Upon completion, participant will be able to identify factors associated with development of an incident geriatric syndrome after oncologic resection for stage I-III gastrointestinal cancer.
Upon completion, participant will be able to list the short-term postoperative outcomes associated with development of an incident geriatric syndrome in patients after oncologic resection for stage I-III gastrointestinal cancer.