Comprehensive geriatric assessment prediction of postoperative complications in gastrointestinal cancer patients: a meta-analysis

Figures & data

Table 1 Characteristics of the included studies

Study (country)	Design (duration of study)	Cancer type	Sample size	Mean age (years)	Outcome			Main conclusion
					30-day postoperative any complications (n, %)	30-day postoperative major complications (n, %)	90-day postoperative major complications (n, %)
Kenig et al^Citation14 (Poland)	Cohort study (2013–2014)	Colorectal cancer 66.6%, gastric cancer 10.7%, others 22.7%	75	73	38, 50.7	20, 26.7	–	TUGT and MOS-SSS were predictive factors of postoperative morbidity (both any and major complications); polypharmacy was an independent risk factor of 30-day postoperative major complications
Tan et al^Citation18 (Singapore)	Cohort study (2008–2010)	Colorectal cancer	83	81.5	–	22, 26.5	–	Patients with frailty had a significant four times higher risk of developing 30-day postoperative major complications
Pujara et al^Citation19 (USA)	Cohort study (2005–2014)	Gastric and gastroesophageal cancers	279	64	–	–	67, 24	Pain scale score >0, ≥10% weight loss and polypharmacy were independently associated with 90-day postoperative major morbidity
Lee et al^Citation13 (Korea)	Cohort study (2009–2014)	Colon tumor 62.5%, rectum tumor 37.5%	240	76.7	183, 76.3	99, 41.3	–	A score of ≥3 for comorbidities and a high ADL score were significantly and independently associated with a risk of major complications
Kristjansson et al^Citation17 (Norway)	Cohort study (2006–2008)	Colon tumor 71%, rectum tumor 29%	182	80	–	–	–	Severe comorbidity was the only CGA element predicting major complications; IADL dependency and depression were predictors of any complications
Kristjansson et al^Citation16 (Norway)	Cohort study (2006–2008)	Colon tumor 71%, rectum tumor 29%	178	79.6	107, 60.1	83, 46.6	–	Frailty was significantly associated with both any complications and major complications

Abbreviations: TUGT, Timed Up and Go Test; MOS-SSS, Medical Outcomes Study Social Support Scale; ADL, activities of daily living; CGA, comprehensive geriatric assessment; IADL, instrumental activities of daily living.

Figure 1 Flowchart of study search and selection process.

Abbreviations: JBI, Joanna Briggs Institute; CBM, Chinese Biomedical Literature Database; CNKI, China National Knowledge Infrastructure; CGA, comprehensive geriatric assessment.

Table 2 Elements of CGA and assessment tools

Study	CGA
	Comorbidity	Polypharmacy	FS			Cognition	Depression	Nutritional status				Frailty	Falls	Pain	Physical activity	Fatigue	Social support	Delirium
Kenig et al^Citation14	CCI, CIRS and Satariano’s index	≥4 and ≥5	ADL	IADL	–	MMSE, CDT and BOMC	GDS	MNA	–	–	–	–	–	–	TUGT	BFI	MOS-SSS	–
Tan et al^Citation18	CCI	≥5	–	–	–	–	–	–	–	Serum albumin	BMI	Fried criteria	–	–	–	–	–	–
Pujara et al^Citation19	CCI	≥5	–	–	–	–	–	–	Weight loss	Serum albumin	–	–	Falls history	0–10 scale	–	–	–	–
Lee et al^Citation13	CCI	≥8	ADL	IADL	–	MMSE	GDS	MNA	–	Serum albumin	–	–	–	–	–	–	–	NDSS
Kristjansson et al^Citation17	CIRS	≥5	ADL	–	BI	MMSE	GDS	MNA	–	–	–	–	–	–	–	–	–	–
Kristjansson et al^Citation16	CIRS	≥5	ADL	–	BI	MMSE	GDS	MNA	–	–	–	Based on CGA	–	–	–	–	–	–

Abbreviations: CGA, comprehensive geriatric assessment; FS, functional status; CCI, Charlson Comorbidity Index; CIRS, Cumulative Illness Rating Scale; ADL, activities of daily living; IADL, instrumental activities of daily living; MMSE, Mini-Mental State Examination; CDT, Clock Drawing Test; BOMC, Blessed Orientation Memory Concentration; GDS, Geriatric Depression Scale; MNA, Mini Nutritional Assessment; TUGT, Timed Up and Go Test; BFI, Brief Fatigue Inventory; MOS-SSS, Medical Outcomes Study Social Support Scale; BMI, Body Mass Index; NDSS, Nursing Delirium Screening Scale; BI, Barthel Index.

Table 3 Quality assessment

Study	Selection				Comparability of cohorts	Outcome
	Representativeness of the exposed cohort	Selection of the non exposed cohort	Ascertainment of exposure	Outcome not present at start		Assessment of outcome	Follow-up long enough?	Adequacy of F-U	Total scores
Kenig et al^Citation14	✩	✩	–	✩	✩✩	✩	✩	✩	8
Tan et al^Citation18	✩	✩	–	✩	✩✩	–	✩	✩	7
Lee et al^Citation13	✩	✩	✩	✩	–	–	✩	✩	6
Pujara et al^Citation19	✩	✩	–	✩	–	–	✩	✩	5
Kristjansson et al^Citation17	✩	✩	✩	✩	✩✩	✩	✩	✩	9
Kristjansson et al^Citation16	✩	✩	–	✩	✩✩	✩	✩	✩	8

Notes: The Newcastle-Ottawa Scale (NOS) evaluates each study on eight items grouped into three categories including the study population selection, comparability, and outcome. A study can be awarded one star for each item within the selection and outcome categories and two stars for comparability. One star refers to a score of 1 and studies with a total score of ≥7 were considered as high quality studies.

Abbreviation: F-U, follow-up.

Figure 2 Effects of comorbidity on 30-day postoperative major complications.

Abbreviations: OR, odds ratio; SE, standard error; IV, inverse variance; CCI, Charlson Comorbidity Index.

Figure 3 Effects of polypharmacy on 30-day postoperative major complications.

Abbreviations: OR, odds ratio; SE, standard error; IV, inverse variance.

Figure 4 Effects of FS on 30-day postoperative major complications.

Abbreviations: FS, functional status; OR, odds ratio; SE, standard error; IV, inverse variance; ADL, activities of daily living; IADL, instrumental activities of daily living.

Figure 5 Effects of cognition on 30-day postoperative major complications.

Abbreviations: OR, odds ratio; SE, standard error; IV, inverse variance; MMSE, Mini-Mental State Examination.

Figure 6 Effects of nutrition on 30-day postoperative major complications.

Abbreviations: OR, odds ratio; SE, standard error; IV, inverse variance; MNA, Mini Nutritional Assessment.

Figure 7 Effects of depression on 30-day postoperative major complications.

Abbreviations: OR, odds ratio; SE, standard error; IV, inverse variance.

KenigJOlszewskaUZychiewiczBBarczynskiMMituś-KenigMCumulative deficit model of geriatric assessment to predict the postoperative outcomes of older patients with solid abdominal cancerJ Geriatr Oncol2015637037926144556

 PubMed Web of Science ®Google Scholar

TanKYKawamuraYJTokomitsuATangTAssessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimizedAm J Surg2012204213914322178483

 PubMed Web of Science ®Google Scholar

PujaraDMansfieldPAjaniJComprehensive geriatric assessment in patients with gastric and gastroesophageal adenocarcinoma undergoing gastrectomyJ Surg Oncol2015112888388726482869

 PubMed Web of Science ®Google Scholar

LeeYHOhHKKimDWUse of a comprehensive geriatric assessment to predict short-term postoperative outcome in elderly patients with colorectal cancerAnn Coloproctol201632516116927847786

 PubMedGoogle Scholar

KristjanssonSRJordhøyMSNesbakkenAWhich elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery?J Geriatr Oncol2010125765

 Web of Science ®Google Scholar

KristjanssonSRNesbakkenAJordhøyMSComprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort studyCrit Rev Oncol Hematol201076320821720005123

 PubMed Web of Science ®Google Scholar