Identifying the impact of pre-operative assessment scores on functional recovery of the elderly colorectal surgical patient
Yap, Hong Wan
Date of Issue2017-09-04
Lee Kong Chian School of Medicine (LKCMedicine)
Background: With the emergence of an aging population, there is an increased need to risk stratify and optimize surgical management in the elderly due to their poorer baseline functional status as well as a higher risk of post-surgical complications compared to the younger population. Pre-operative risk assessments have been used to predict poorer surgical outcomes. With this study, we aim to identify the independent variables that are significant in affecting the functional recovery of the patient postoperatively. Methods: Data was collected from a transdisciplinary geriatric surgery service and includes patients aged 75 and older. Data includes pre-operative risk assessments such as ASA, POSSUM, laboratory values like CEA markers and these are analysed with the surgical outcome of functional recovery, which we defined as a reduction in the Barthel Index post-operatively at 6 weeks compared to pre-operative baseline. Multivariate analysis was performed to identify the independent variables that were significant in predicting a poorer functional outcome. Results Out of the 66 patients, 18 patients still had a reduced Barthel Index compared to pre-operatively. POSSUM Physiological Score and Stage 3 Colorectal Cancer had a statistically significant impact on predicting a poorer functional recovery 6 weeks post-operatively (P values 0.0339 and 0.00675 respectively). The nature of operations and other scoring systems like Frailty, ASA, Weighted Charlson Comorbidity Index, and nutritional status did not have any significant impact on the prediction of the failure in functional recovery 6 weeks post-operation. Conclusion Possum Physiological Scores and Cancer stage 3 are independent predictors of predicting a poorer functional recovery 6 weeks post-surgery. This can help the elderly patient to decide if surgery is the best option available to them and also provide an insight onto the areas in which we can look to optimize the patient before deciding to undergo surgery.
Final Year Project (FYP)