Geriatric Assessment, Not ASA Physical Status, Is Associated With 6-Month Postoperative Survival in Patients With Cancer Aged ≥75 Years

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Background: The American Society of Anesthesiologists physical status (ASA PS) classification system is the most common method of assessing preoperative functional status. Comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool for preoperative assessment of older adults. The goal of this study was to assess the correlation between ASA classification and CGA deficits among oncogeriatric patients and to determine the association of each with 6-month survival. Patients and Methods: Oncogeriatric patients (aged ≥75 years) who underwent preoperative CGA in an outpatient geriatric clinic at a single tertiary comprehensive cancer center were identified. All patients underwent surgery, with a hospital length of stay (LOS) ≥1 day and at least 6 months of follow-up. ASA classifications were obtained from preoperative anesthesiology notes. Preoperative CGA scores ranged from 0 to 13. Six-month survival was assessed using the Social Security Death Index. Results: In total, 81 of the 980 patients (8.3%) included in the study cohort died within 6 months of surgery. Most patients were classified as ASA PS III (85.4%). The mean number of CGA deficits for patients with PS II was 4.03, PS III was 5.15, and PS IV was 6.95 (P<.001). ASA classification was significantly associated with age, preoperative albumin level, hospital LOS, and 30-day intensive care unit (ICU) admissions. On multivariable analysis, 6-month mortality was associated with number of CGA deficits (odds ratio [OR], 1.14 per each unit increase in CGA score; P=.01), 30-day ICU admissions (OR, 2.77; P=.003), hospital LOS (OR, 1.03; P=.02), and preoperative albumin level (OR, 0.36; P=.004). ASA classification was not associated with 6-month mortality. Conclusions: Number of CGA deficits was strongly associated with 6-month mortality; ASA classification was not. Preoperative CGA elicits critical information that can be used to enhance the prediction of postoperative outcomes among older patients with cancer.

Submitted October 11, 2018; accepted for publication January 17, 2019.Previous presentation: This study was presented in part at the 16th Annual Conference of the International Society of Geriatric Oncology; November 17–19, 2016; Milan, Italy.Author contributions: Study concept and design: Shahrokni. Data acquisition and quality control: Shahrokni, Sarraf. Data analysis and interpretation: Shahrokni, Vishnevsky, Jang, Alexander, Korc-Grodzicki, Downey, Afonso. Statistical analysis: Shahrokni. Drafting of manuscript: All authors. Critical revisions: All authors.Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.Funding: Research reported in this publication was supported, in part, by the Beatriz and Samuel Seaver Foundation, the Memorial Sloan Kettering Cancer and Aging Program, and NIH/NCI Cancer Center Support Grants (P30CA008748 and R25CA020449).Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.Correspondence: Armin Shahrokni, MD, MPH, Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Box 205, 1275 York Avenue, New York, NY 10065. Email: shahroka@mskcc.org
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