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Clinical Investigations: SURGERY |

Importance of a Comprehensive Geriatric Assessment in Prediction of Complications Following Thoracic Surgery in Elderly Patients*

Tatsuo Fukuse, MD; Naoki Satoda, MD; Kyoko Hijiya, MD; Takuji Fujinaga, MD
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*From the Department of Thoracic Surgery (Drs. Fukuse and Fujinaga), Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan; and the Department of Thoracic Surgery (Drs. Satoda and Hijiya), Otsu Red Cross Hospital, Otsu-City, Japan.

Correspondence to: Tatsuo Fukuse, MD, Department of Thoracic Surgery, Faculty of Medicine, Kyoto University, 54 Shogo-in, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; e-mail: fukuse@kuhp.kyoto-u.ac.jp



Chest. 2005;127(3):886-891. doi:10.1378/chest.127.3.886
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Background: The prevalence of comorbidities and functional impairment among elderly patients may enhance the risk of operation-related complications, but the importance of these conditions in elderly patients undergoing thoracic surgery remains unclear.

Methods: One hundred twenty patients ≥ 60 years of age who underwent thoracic surgery were registered prospectively and examined. A comprehensive geriatric assessment (CGA) that evaluated such diverse areas as functional status (ie, performance status and activities of daily living [ADLs] using the Barthel index), comorbidity, nutrition (ie, body mass index, arm-muscle circumference, albumin level, transferrin level, lymphocyte count, and cholinesterase level), and cognitive function (ie, mini-mental state examination [MMSE] and negative emotions for operation) was performed in the 2 weeks before patients underwent the operation.

Results: The diseases of the 120 patients were as follows: lung cancer, 85 patients; mediastinal tumor, 14 patients; bullas, 12 patients; and other diseases, 9 patients. Postoperative complications developed in 20 patients (16.7%). The patients with dependence for performing the ADLs, and dementia were more likely to develop postoperative complications (p = 0.041, and p = 0.0065, respectively). The patients who experienced longer operation times (ie, ≥ 300 min; p = 0.018) were more likely to have complications. The incidence of prolonged air leak in the patients with malnutrition increased seven-fold (p = 0.045) and that of postoperative infectious diseases in those patients with obesity increased 24-fold (p = 0.0013), while all patients who developed delirium had low scores in the MMSE preoperatively (p = 0.0003). Using multiple logistic regression, the best model was obtained with a combination of MMSE (p = 0.031) and the Barthel index (p = 0.04). When the operation variables were added to this model, the operation time had the strongest effect (p = 0.016).

Conclusions: Dependence for the performance of ADLs and impaired cognitive conditions are important predictors of postoperative complications, especially when the operation time is long. CGA is necessary in addition to the conventional cardiopulmonary functional assessment in elderly patients.


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