Advertisement

Predictive value of the G8 and the IADL-modified G8 screening tools for postoperative delirium following major urological cancer surgery

Published:August 26, 2022DOI:https://doi.org/10.1016/j.jgo.2022.08.014

      Abstract

      Introduction

      The purpose of this study was to evaluate whether the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8 are associated with the occurrence of postoperative delirium after major urological cancer surgery.

      Materials and Methods

      We retrospectively analyzed a total of 415 consecutive patients who underwent major urologic cancer surgery and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and July 2021. For both the G8 and the IADL-modified G8, a cut-off value of 14 was used. All patients underwent perioperative management according to the Enhanced Recovery After Surgery protocol formulated at our institution. Delirium was diagnosed using the Confusion Assessment Method. The relationship between these screening tests and clinical variables was examined. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC). To determine the risk factors for the occurrence of postoperative delirium, univariate and multivariate analyses were performed.

      Results

      Of the 415 patients, 160 (39%) were assigned to the low G8 (score ≤ 14) group and 166 (40%) to the low IADL-modified G8 (score ≤ 14) group. The median age of the patients was 72 years. Postoperative delirium occurred in 31 patients (7%). The AUC values for predicting postoperative delirium were 0.69 for the G8 and 0.71 for the IADL-modified G8. Multivariate analysis for the G8 showed that G8 ≤ 14 (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.2–6.0; P = 0.02), preoperative use of benzodiazepine (OR = 3.8; 95% CI = 1.6–8.6; P = 0.002), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5–7.1; P = 0.003) were independent risk factors for postoperative delirium. Similarly, for the IADL-modified G8, IADL-modified G8 ≤ 14 (OR = 2.6; 95% CI = 1.1–5.8; P = 0.02), preoperative use of benzodiazepine (OR = 3.9; 95% CI = 1.7–8.8; P = 0.001), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5–7.2; P = 0.003) were independent risk factors for postoperative delirium.

      Discussion

      The G8 and the IADL-modified G8 screening may allow for better identification of patients at risk of postoperative delirium.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Geriatric Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Karnakis T.
        • Gattás-Vernaglia I.F.
        • Saraiva M.D.
        • Gil-Junior L.A.
        • Kanaji A.L.
        • Jacob-Filho W.
        The geriatrician’s perspective on practical aspects of the multidisciplinary care of older adults with cancer.
        J Geriatr Oncol. 2016; 7 (Epub 20160801): 341-345
        • Centers for Disease Control and Prevention
        United States Cancer Statistics: Male Urologic Cancers. USCS Data Brief, no 21.
        Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, GA2020
        • Hurria A.
        • Mohile S.G.
        • Dale W.
        Research priorities in geriatric oncology: addressing the needs of an aging population.
        J Natl Compr Cancer Netw. 2012; 10: 286-288https://doi.org/10.6004/jnccn.2012.0025
        • Wildiers H.
        • Heeren P.
        • Puts M.
        • Topinkova E.
        • Janssen-Heijnen M.L.
        • Extermann M.
        • et al.
        International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer.
        J Clin Oncol. 2014; 32: 2595-2603https://doi.org/10.1200/jco.2013.54.8347
        • Dale W.
        • Williams G.R.
        • Mac Kenzie A.
        • Soto-Perez-de-Celis E.
        • Maggiore R.J.
        • Merrill J.K.
        • et al.
        How is geriatric assessment used in clinical practice for older adults with cancer? A survey of Cancer providers by the American Society of Clinical Oncology.
        JCO Oncol Prac. 2020; 17: 336-344https://doi.org/10.1200/OP.20.00442
        • Shahrokni A.
        • Tin A.
        • Downey R.J.
        • Strong V.
        • Mahmoudzadeh S.
        • Boparai M.K.
        • et al.
        Electronic rapid fitness assessment: a novel tool for preoperative evaluation of the geriatric oncology patient.
        J Natl Compr Cancer Netw. 2017; 15: 172-179https://doi.org/10.6004/jnccn.2017.0018
        • Extermann M.
        • Aapro M.
        • Bernabei R.
        • Cohen H.J.
        • Droz J.P.
        • Lichtman S.
        • et al.
        Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG).
        Crit Rev Oncol Hematol. 2005; 55: 241-252https://doi.org/10.1016/j.critrevonc.2005.06.003
        • Bellera C.A.
        • Rainfray M.
        • Mathoulin-Pélissier S.
        • Mertens C.
        • Delva F.
        • Fonck M.
        • et al.
        Screening older cancer patients: first evaluation of the G-8 geriatric screening tool.
        Ann Oncol. 2012; 23 (Epub 20120116): 2166-2172
        • van Walree I.C.
        • Scheepers E.
        • van Huis-Tanja L.
        • Emmelot-Vonk M.H.
        • Bellera C.
        • Soubeyran P.
        • et al.
        A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer.
        J Geriatr Oncol. 2019; 10 (Epub 20190508): 847-858
        • Martinez-Tapia C.
        • Canoui-Poitrine F.
        • Bastuji-Garin S.
        • Soubeyran P.
        • Mathoulin-Pelissier S.
        • Tournigand C.
        • et al.
        Optimizing the G8 screening tool for older patients with cancer: diagnostic performance and validation of a six-item version.
        Oncologist. 2016; 21 (Epub 20160113): 188-195
        • Petit-Monéger A.
        • Rainfray M.
        • Soubeyran P.
        • Bellera C.A.
        • Mathoulin-Pélissier S.
        Detection of frailty in elderly cancer patients: improvement of the G8 screening test.
        J Geriatr Oncol. 2016; 7 (Epub 20160208): 99-107
        • Karnakis T.
        • Gattás-Vernaglia I.F.
        • Dos Santos Hughes S.F.
        • Aliberti M.J.R.
        Rapid geriatric risk screening and survival in older adults with cancer: prognostic value of the IADL-modified G8.
        J Geriatr Oncol. 2022; 13 (Epub 20211009): 381-383
        • Barberger-Gateau P.
        • Dartigues J.F.
        • Letenneur L.
        Four instrumental activities of daily living score as a predictor of one-year incident dementia.
        Age Ageing. 1993; 22: 457-463https://doi.org/10.1093/ageing/22.6.457
        • Barberger-Gateau P.
        • Fabrigoule C.
        • Rouch I.
        • Letenneur L.
        • Dartigues J.F.
        Neuropsychological correlates of self-reported performance in instrumental activities of daily living and prediction of dementia.
        J Gerontol B Psychol Sci Soc Sci. 1999; 54: P293-P303https://doi.org/10.1093/geronb/54b.5.p293
        • Yajima S.
        • Nakanishi Y.
        • Matsumoto S.
        • Ookubo N.
        • Tanabe K.
        • Kataoka M.
        • et al.
        The Mini-Cog: A simple screening tool for cognitive impairment useful in predicting the risk of delirium after major urological cancer surgery.
        Geriatr Gerontol Int. 2022; 22 (Epub 20220306): 319-324
        • Japanese Ministry of Health, Labour and Welfare,
        • Hara T.
        • Matsuyama H.
        • Kamiryo Y.
        • Hayashida S.
        • Yamamoto N.
        • Nasu T.
        • et al.
        Use of preoperative performance status and hemoglobin concentration to predict overall survival for patients aged ≥ 75 years after radical cystectomy for treatment of bladder cancer.
        Int J Clin Oncol. 2016; 21 (Epub 20150616): 139-147
        • Palumbo C.
        • Knipper S.
        • Pecoraro A.
        • Rosiello G.
        • Luzzago S.
        • Deuker M.
        • et al.
        Patient frailty predicts worse perioperative outcomes and higher cost after radical cystectomy.
        Surg Oncol. 2020; 32 (Epub 20191025): 8-13
        • Kalis V.
        • Smazinka M.
        • Rusavy Z.
        • Blaganje M.
        • Havir M.
        • Havelkova L.
        • et al.
        Laparoscopic sacrocolpopexy as the mainstay management for significant apical pelvic organ prolapse (LAP) study.
        Eur J Obstet Gynecol Reprod Biol. 2020; 244 (Epub 20191109): 60-65
      1. Anxiety disorders. In diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association, 2013https://doi.org/10.1176/appi.books.9780890425596.dsm05
        • DeLong E.R.
        • DeLong D.M.
        • Clarke-Pearson D.L.
        Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.
        Biometrics. 1988; 44: 837-845
        • Hamaker M.E.
        • Jonker J.M.
        • de Rooij S.E.
        • Vos A.G.
        • Smorenburg C.H.
        • van Munster B.C.
        Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review.
        Lancet Oncol. 2012; 13: e437-e444https://doi.org/10.1016/s1470-2045(12)70259-0
        • Baitar A.
        • Van Fraeyenhove F.
        • Vandebroek A.
        • De Droogh E.
        • Galdermans D.
        • Mebis J.
        • et al.
        Evaluation of the Groningen Frailty Indicator and the G8 questionnaire as screening tools for frailty in older patients with cancer.
        J Geriatr Oncol. 2013; 4 (Epub 20120824): 32-38
        • Soubeyran P.
        • Bellera C.
        • Goyard J.
        • Heitz D.
        • Curé H.
        • Rousselot H.
        • et al.
        Screening for vulnerability in older cancer patients: the ONCODAGE prospective multicenter cohort study.
        PLoS One. 2014; 9 (Epub 20141211): e115060
        • Segernäs A.
        • Skoog J.
        • Ahlgren Andersson E.
        • Almerud Österberg S.
        • Thulesius H.
        • Zachrisson H.
        Prediction of postoperative delirium after cardiac surgery with a quick test of cognitive speed, mini-mental state examination and hospital anxiety and depression scale.
        Clin Interv Aging. 2022; 17 (Epub 20220402): 359-368
        • Wu Y.
        • Shi Z.
        • Wang M.
        • Zhu Y.
        • Li C.
        • Li G.
        • et al.
        Different MMSE score is associated with postoperative delirium in young-old and old-old adults.
        PLoS One. 2015; 10 (Epub 20151013): e0139879
        • Mitchell A.J.
        • Shukla D.
        • Ajumal H.A.
        • Stubbs B.
        • Tahir T.A.
        The Mini-Mental State Examination as a diagnostic and screening test for delirium: systematic review and meta-analysis.
        Gen Hosp Psychiatry. 2014; 36 (Epub 20140909): 627-633
        • Mantel N.
        Why stepdown procedures in variable selection.
        Technometrics. 1970; 12: 621-625https://doi.org/10.1080/00401706.1970.10488701
        • Austin P.C.
        • Tu J.V.
        Automated variable selection methods for logistic regression produced unstable models for predicting acute myocardial infarction mortality.
        J Clin Epidemiol. 2004; 57: 1138-1146https://doi.org/10.1016/j.jclinepi.2004.04.003
        • Sauerbrei W.
        • Perperoglou A.
        • Schmid M.
        • Abrahamowicz M.
        • Becher H.
        • Binder H.
        • et al.
        State of the art in selection of variables and functional forms in multivariable analysis—outstanding issues.
        Diagn Progn Res. 2020; 4: 3https://doi.org/10.1186/s41512-020-00074-3