Preoperative geriatric assessment (GA) and surgical outcomes in older women with gynecological (gyn) cancer.

Abstract

5108 Background: GA can predict surgical outcomes in older patients (pts); however, pre-surgical evaluation for older pts with gyn malignancies has not been well-described. This study will determine the association between GA variables with post-operative morbidity and mortality. Methods: Women 75yrs or older who had geriatric evaluation before any gyn surgery at Memorial Sloan Kettering Cancer Center (MSKCC) between 1/2010-6/2011 were identified. Pre-operative GA included: Mini-Cog Test (cognition), fall history, medication list, nutritional status (weight loss >10lbs, albumin), functional status (activities of daily living (ADL), instrumental I-ADL), and Charlson comorbidity index. Outcomes included: delirium, length of hospital stay (LOS), 30-day surgical adverse events (AE, grade 1-5, via prospective-MSKCC surgical database), 30-day hospital readmission and 6-month mortality. Utilizing bivariate analyses, associations between GA measures and post-operative outcomes were evaluated. Results: 72 pts (median age 79yrs, range 75-92) with gyn cancer (54% uterine, 36% ovarian/peritoneal/tubal, 10% cervical/vaginal/vulvar) had gyn surgery. 34 pts (47%) had stage III/IV disease. 21pts (30%) had secondary cancer history. Pt’s baseline GA measures: ADL-dependent (13%), IADL-dependent (19%), weight loss (18%), fall history (18%), mini cog score (median 4, range 0-5), Charlson score (median 2, range 0-9). 24pts (33%) had surgical AE; no significant association with age or GA. Median LOS was 2 days (range 0-20); 11pts (15%) required 30-day readmission. Delirium (p=0.01), nutrition (weight loss p=0.04, albumin p=0.04), anemia (p=0.003) and high comorbidity index (p=0.013) were associated with longer LOS. Six-month mortality was 8%; older age (p=0.02), poor functional status (lower ADL and IADL, p<0.001 and p=0.007), number of medications (p=0.05) and poor cognition (p<0.001) were associated with shorter survival. Conclusions: Surgical morbidity is common in older pts. Although AE’s were not associated with GA variables, GA can detect high-risk features for longer LOS and shorter survival. Further prospective studies with pre-operative GA and interventions are warranted.