Some Nursing Screening Tools Can Be Used to Assess High-Risk Older Adults Who Undergo Colorectal Surgery for Cancer

Abstract

Lisa Cooper,1,2 Baha Siam,2,3 Aviv Sagee,2,4 Ran Orgad,2,3 Yochai Levi,1,2 Nir Wasserberg,2,3 Yichayaou Beloosesky,1,2 Hanoch Kashtan2,3 1Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel; 2The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; 3Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel; 4Department of Internal Medicine C, Rabin Medical Center, Campus Beilinson, Petah Tiqva, IsraelCorrespondence: Hanoch KashtanDepartment of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tikva 49100, IsraelTel [phone]Fax [phone]Email [email protected]: Life expectancy and incidence of cancer among older adults are increasing. The aim of this study was to assess whether routinely used nursing screening tools can predict surgical outcomes in older adults with colorectal cancer.Methods: Data of patients who underwent elective colorectal cancer surgery at Rabin Medical Center during the years 2014– 2016 were collected retrospectively. Patients were divided into study group (age 80– 89 y), and control group (age 60– 69 y) for comparing surgical outcomes and six-month mortality. In the study group, screening tool scores were evaluated as potential predictors of surgical outcomes. These included Malnutrition Universal Screening Tool (MUST), Admission Norton Scale Scores (ANSS), Morse Fall Scale (MFS), and Charlson Co-morbidity Index (CCI).Results: The study group consisted of 77 patients, and the control group consisted of 129 patients. Postoperative mortality and morbidity were similar in both groups. Nursing screening tools did not predict immediate postoperative outcomes in the study group. MUST and CCI were predictors for six-month mortality. CCI score was 9.43± 2.44 in those who died within six months from surgery compared to 7.07 ± 1.61 in those who were alive after six months (p< 0.05). Post-operative complications were not associated with increased 30-day mortality. Advanced grade complications were associated with an increased six-month mortality (RR=1.37, 95% CI 0.95– 1.98, p=0.013).Conclusion: Different screening tools for high-risk older adults who are candidates for surgery have been developed, with the caveat of necessitating skilled physicians and resources such as time. Routinely used nursing screening tools may be helpful in better patient selection and informed decision making. These tools, specifically MUST and CCI who were found to predict six-month survival, can be used to additionally identify high-risk patients by the nursing staff and promote further evaluation. This can be a valuable tool in multidisciplinary and patient-centered care.Keywords: colorectal cancer, nursing screening tools, octogenarians, post-operative outcomes, pre-operative assessment

Keywords

• colorectal cancer
• nursing screening tools
• octogenarians
• post-operative outcomes
• pre-operative assessment