Impact of CGA and Surgical Risk Calculator before elective cancer surgery on postoperative delirium in elderly patients

Comprehensive Geriatric Assessment (CGA) is part of preoperative evaluation for frail elderly patients; Surgical Risk Calculator (SRC) from the American College of Surgeons National Surgical Quality Improvement Project can enhance this assessment by estimating the risk of postoperative complications (POCs) within 30 days, particularly postoperative delirium (POD).

Our primary objective was to identify CGA and/or SRC characteristics associated with POD within 30 days of oncological surgery in elderly patients. Our secondary objective was to determine the rates of 30-day POD, mortality, and readmission.

A single-centre retrospective observational study was conducted at the Marseille University Hospital between July 2021 and December 2022, involving patients aged 70 years and older who received a favourable geriatric assessment prior to surgery.

Of the 161 patients included in the study (mean age of 80.6 years), 10.0% experienced postoperative delirium (POD), 8.1% died, and 14.9% were readmitted within 30 days of surgery. Risk factors for POD identified in multivariate analysis were age between 85 and 89 years and estimated risk of POD by SRC. Estimated risk of POD by SRC had an area under the curve of 0.89 in our sample.

SRC is a promising tool to add to CGA for assessing the risk of postoperative delirium in older cancer patients. Taking nutritional status into account improves postoperative geriatric care in this population.