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

Abstract

Background: Gastrointestinal cancer is an age-associated disease, and geriatric patients are mostly likely to suffer from postoperative complications. Some studies indicated that comprehensive geriatric assessment (CGA) could predict postoperative complications in gastrointestinal cancer patients. However, the evidence is mixed.

Objective: This study aimed to conduct a meta-analysis to identify the effectiveness of CGA for predicting postoperative complications in gastrointestinal cancer patients.

Methods: The Joanna Briggs Institute Library, Cochrane Library, PubMed, Embase, Web of Science, CINAHL Complete and four Chinese databases were searched for studies published up to March 2017. Two reviewers independently screened literature, extracted data and assessed the quality of included studies. RevMan5.3 was used for meta-analysis or only descriptive analysis.

Results: Six studies were included, with 1,037 participants in total. In all, 13 components of CGA were identified, among which comorbidity (Charlson Comorbidity Index [CCI] ≥3; odds ratio [OR]=1.31, 95% CI [1.06, 1.63], P=0.01), polypharmacy (≥5 drugs/day; OR=1.30, 95% CI [1.04, 1.61], P=0.02) and activities of daily living (ADL) dependency (OR=1.69, 95% CI [1.20, 2.38], P=0.003) were proven relevant to the prediction of postoperative complications. No conclusive relationship was established between instrumental activities of daily living (IADL) dependency (OR=1.18, 95% CI [0.73, 1.91], P=0.51), Mini-Mental State Examination (MMSE; OR=1.13, 95% CI [0.91, 1.41], P=0.27), potential malnutrition (OR=1.07, 95% CI [0.87, 1.31], P=0.54), malnutrition (OR=1.26, 95% CI [0.80, 1.99], P=0.32), Geriatric Depression Scale (GDS; OR=1.18, 95% CI [0.90, 1.55], P=0.24) and postoperative complications.

Conclusion: Comorbidity (CCI ≥3), polypharmacy (≥5 drugs/day) and ADL dependency were predictive factors for postoperative complications in gastrointestinal cancer patients; the results of other geriatric instruments were not conclusive, pointing to insufficient studies and requirement of more original investigations.

Keywords: complication; comprehensive geriatric assessment; gastrointestinal cancer; meta-analysis.

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.

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.