Prediction of major surgical complications by comprehensive geriatric assessment in elderly patients with gynecologic cancers: A prospective cohort study.

Abstract

e15503 Background: To evaluate the ability of a preoperative comprehensive geriatric assessment (CGA) to predict the risk of postoperative complications in elderly patients who underwent primary surgery for gynecologic cancers. Methods: Fifty-six consecutive patients (24 ovarian, 15 cervical, 6 endometrial, 5 uterine sarcoma, 4 vulvar, and 2 metastatic cancers) older than 70 years scheduled to take surgery electively for gynecologic cancer were preoperatively assessed by CGA. Every category of CGA was evaluated for in-hospital postoperative complications and mortality within 30 days of surgery. Major complication included any complication of 2 or higher grade according to Memorial Sloan-Kettering Surgical Complication Criteria 12/99. Results: Mean age was 73.5±3.5 years (range 70-85). Overall postoperative complication rate was 28.6% (16/56) with 7 (12.5%) and 6 (10.7%) being major and multiple complications, respectively. Mean hospital stay was 18.7±13.6 days (range 3-81), during which in-hospital mortality was 2 (3.6%). There was no postoperative complication that occurred after discharge within 30 days of surgery. Dependent instrumental activity of daily living (IADL) was associated with high incidence of postoperative complication, especially for multiple complications. However, poor performance status (PS) was associated only with major and multiple complications. Multivariate regression analysis revealed that only poor PS was associated with postoperative in-hospital mortality (p=0.006). Conclusions: IADL and PS were useful to predict postoperative complication, in particular, major and multiple complications, in elderly patients with gynecologic cancers. Major and multiple postoperative complications can be prevented by identifying the elderly patients with gynecologic cancers who showed dependent IADL and poor PS in CGA.