In a single-institution study reported in JAMA Network Open, Shahrokni et al found that postoperative care comanaged by the geriatrics service and surgical service was associated with reduced 90-day postoperative mortality vs care managed by the surgical service alone among patients aged 75 and older with cancer.
“This cohort study found that geriatric comanagement was associated with significantly lower 90-day postoperative mortality among older patients with cancer. These findings suggest that such patients may benefit from geriatric comanagement, which could improve their ability to survive adverse postoperative events.”— Shahrokni et al
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Study Details
The study involved data from 1,892 retrospectively identified patients age ≥ 75 who underwent cancer-related surgical treatment at Memorial Sloan Kettering Cancer Center between February 2015 and February 2018. The cohort included patients with various tumor types who had elective surgical treatment within 60 days of their first visit with the surgeon and required a hospital stay of at least 1 day. Multivariate analysis of the effect of geriatric comanagement on 90-day mortality was adjusted for age, sex, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index score, preoperative albumin level, operative time, and estimated blood loss. A similar analysis was used to assess the association with adverse surgical events, defined as any major complication, readmission, or emergency department visit within 30 days.
Key Findings
Among the 1,892 patients, 1,020 (53.9%) received geriatric comanagement; compared with patients who received surgery service care only, these patients were older (mean age = 81 vs 80 years, P < .001), had a longer operative time (mean = 203 vs 138 minutes, P < .001), and a longer length of hospital stay (median = 5 vs 4 days, P < .001). There was no difference in sex distribution (47.8 vs 51.6% male, P = .11).
Risk of adverse surgical outcomes within 30 days did not differ between groups (odds ratio [OR] = 0.93, P = .54); rates were 20.6% in the geriatric comanagement group vs 21.8% in the surgical service group.
Unadjusted 90-day mortality was 3.5% in the geriatric comanagement group vs 10.6% in the surgical service group. On multivariate analysis, patients in the geriatric comanagement group were less likely to die within 90 days (OR = 0.43, P < .001), with the adjusted probability of death within 90 days being 4.3% vs 8.9%. With the addition of adverse surgical outcomes to the multivariate analysis, 90-day mortality remained significantly lower in the geriatric comanagement group (OR = 0.44, P < .001).
Compared with patients who received surgery service care only, higher proportions of patients in the geriatric comanagement group received inpatient supportive care services, including physical therapy (80.4% vs 63.6%, P < .001), occupational therapy (37.7% vs 25.2%, P < .001), speech and swallow rehabilitation (8.4% vs 4.8%, P = .002), and nutrition services (78.7% vs 73.1%, P = .004).
The investigators concluded, “This cohort study found that geriatric comanagement was associated with significantly lower 90-day postoperative mortality among older patients with cancer. These findings suggest that such patients may benefit from geriatric comanagement, which could improve their ability to survive adverse postoperative events.”
Armin Shahrokni, MD, MPH, of the Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was supported in part by the Beatriz and Samuel Seaver Foundation, Memorial Sloan Kettering Cancer and Aging Program, and a grant from the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
