Characteristics of older patients undergoing major oncological surgery: Insights from the Geriatric Surgery Verification Program

Introduction

Studies outlining the unique burden of geriatric medical conditions and syndromes among older adults undergoing major oncological surgery are lacking, along with understanding of the goals of care for this population.

Materials and Methods

We conducted a single-institutional review of the initial 50 patients who enrolled in the American College of Surgeons' Geriatric Surgery Verification Program (GSV) program implemented for those ≥65 years undergoing major oncological surgery during the year 2023. Patient variables were categorized into four domains - somatic, functional, psychological, and social. The impact of GSV was analyzed by comparing the GSV cohort to historical controls from 2021 using patients' goals of care as the outcome of interest.

Results

The mean age of participants was 75.4 years (± 7.5). They were mostly White (72 %), English-speaking (78 %), with similar distribution of sex (54 % female). In the somatic category, nearly 40 % were at moderate to high nutrition risk and 61.5 % had a Geriatric 8 score of ≤14. In the functional category, 34.7 % used a cane or walker, 6.4 % had history of falls, and 22.4 % had some degree of frailty. In the psychological category, >70 % reported some degree of depression. Delirium risk factors were identified in 43 % of the patients. In the social category, more than half (54.3 %) of patients were never married, widowed, or divorced. Financial distress screening was positive in 23.3 %. In regard to goals of care, most patients (79.3 %) reported wanting to maintain independence while only 37.9 % reported extending life as primary concern. Using a composite adverse outcome (CAE) variable incorporating 30-day mortality and institutionalization 30-days after discharge as surrogate for these goals, we found that GSV group had an 8.0 % 30-day CAE rate compared to 28.9 % in the historical controls (p = 0.01).

Discussion

We found high proportions of patients with low G8 score, frailty, perioperative risk of falls and delirium, lack of social support, and financial distress. To meet the care goals of this population, a comprehensive geriatric surgery program is essential to preoperatively capture and mitigate risk factors.