Can Preoperative Assessment of Cancer in the Elderly PACE predict 30days postoperative outcome

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Can Pre-operative Assessment of Cancer in the
Elderly (PACE) predict 30days postoperative
outcome?

• HSJ Ramesh, DP Pope, R Gennari, G Corsini, M
  Maffezzini,
• HJ Hoekstra, D Mobarak, K Sunouchi, F Bozzetti,
  M Colledan,
• H Wildiers,A Stotter, RA Audisio
• Whiston Hosp, Un Liverpool, Milton Keynes Gen
  Hosp, Leicester Royal Inf UK
• EIO, Un. of Genoa, Osp. Galliera, Osp. di Prato,
  Osp. Riuniti Bergamo Italy
• Academic Hosp Groningen - the Netherlands
  Gasthuisberg Belgium
• Kawakita Hosp Japan
• SIOG Surgical Task Force

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Background

• Elderly population is expanding

Ageing risk factor for cancer
Elderly are treated sub-optimally
Selected surgical data available
Need for a tool to assess surgical risk
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Predicting Surgical Outcomes
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Operative Assessment
ASA
POSSUM P-POSSUM
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Functional Assessment
MMS Satarianos (modified index) ADL IADL G
DS BFI
CGA
ECOG PS
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Operative assessment tools

Functional assessment tools

PACE
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Materials Methods

• Prospective consecutive multi-centre study
• July 2003 December 2005
• Components
• Interview with trial nurse 20 minutes
• Anaesthesiologists Assessment ASA
• Surg. Assessment POSSUM/P POSSUM

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Aims

• 30 days morbidity
• 30 days mortality
• hospital bed days

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Eligibility
Inclusion gt 70 years Elective cancer
surgery (moderate/major and major )
Written informed consent
Exclusion Emergency Surgery MMS lt18
(consent giving)
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Results - I

• Total Patients 460
• F M 1.9
• Age (yrs) median 76.9
• (69 95 yrs)
• Cancer types
• Breast 47.2 (217)
• GIT 31.3 (144)
• GUT 15.4 (71)
• Miscellaneous 7.1 (28)
• (HN, Gyn, STS, Pulm)

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Results II
Co-morbidity 83 (346) Median n./pt 2.15 (1
-7)

Top five co-morbidities Hypertension 53.6
(246) Digestive diseases 22.0 (101) Heart
disease 21 (96) Arthrosis
Arthritis 19.2 (88) Vascular diseases 14.4 (66
)
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Results III
Observed 30-days morbidity 37.8 (171) 65 74
yrs 34.4 (62) 75 84 yrs 42.1
(96) 85 28.9 (13)
Observed 30-days mortality 3.5 (16)
Median hospital stay 9 days (1 -14)
No significant difference by age groups was
observed for post surgical outcome
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PACE morbidity
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PACE morbidity multivariate analysis
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Morbidity by PACE variables
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PACE mortality
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PACE Hospital stay
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PACE Hospital Stay multivariate analysis
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Hospital stay by PACE(5 days) variables
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Conclusions I morbidity

• PACE variables (significant)
• PS (gt1) 2.9 x risk
• IADL (dependency) 2.1 x risk
• BFI 2.3 x risk
• Not significant
• MMS
• GDS
• ASA
• ADL

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Conclusions II Hospital stay

• PACE variables associated with
• prolonged hospital stay
• IADL (dependent) x 1.64
• BFI x 5.08
• No PACE variable correlated with
• Mortality (observed mortality small)

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PACE - Preparing for future
Thank you