Here - American Geriatrics Society

P OSTER
A BSTRACTS
Aggressive treatment of many cancers includes surgical interventions,
with accompanying risks of morbidity and mortality. There is
substantial heterogeneity in older adults’ functional reserve and ability
to tolerate and recover from major physiological stressors. Geriatric
assessment has developed in the gerontology literature as an important
prognostic tool to risk-stratify community-dwelling older
adults. These principles have been explored with the goal of identifying
patient-level risk factors for adverse surgical outcomes. In this review,
we examined the utility of components of a Comprehensive
Geriatric Assessment (CGA) as predictors of adverse outcomes
among older patients undergoing major surgery.
Methods: Medline, EMBASE, and the Cochrane Library were
searched for prospective studies examining components of CGA
among geriatric patients undergoing elective surgery. Outcome parameters
included 30 day postoperative complications and mortality,
and discharge to a non-home care institution. Within and across the
studies, we evaluated which CGA components were associated with
the outcome(s) of interest.
Results: The initial search identified 125 potentially relevant articles,
of which ten articles based on seven studies met criteria for
evaluation. Across the studies, chronological age was consistently
found not to be an independent predictor of poor outcomes. Dependencies
in ADLs and cognitive impairment were associated with increased
incidence of complications and mortality. Impairment in
IADLs was also associated with discharge to non-home care institutions
in two studies.
Conclusions: Across a diversity of surgical settings and patient
populations, the results of these studies support an association between
poor functional status and adverse geriatric surgical outcomes.
These consistent results argue for inclusion of focused geriatric assessment
as part of routine presurgical care in older adults. In addition,
the development of targeted interventions for vulnerable individuals
so identified may provide innovative means of mitigating the
risk of major surgical interventions for this increasing proportion of
the population.
D164 Encore Presentation
A Pooled Analysis of Surgical Complications: Results from the
RECORD Program.
M. R. Lassen, 1 M. Gent, 2 A. K. Kakkar, 3,4 B. I. Eriksson, 5
S. D. Berkowitz, 6 A. Turpie. 2 1. Glostrup Hospital, Glostrup,
Denmark; 2. McMaster University, Hamilton, ON, Canada; 3.
Thrombosis Research Institute, London, United Kingdom; 4.
University College London, London, United Kingdom; 5. Sahlgrenska
University Hospital, Mölndal, Sweden; 6. Bayer HealthCare
Pharmaceuticals, Montville, NJ.
Supported By: This research was funded by Bayer HealthCare
Pharmaceuticals Inc. and Janssen Research and Development, LLC.
Background: Surgical complications after total hip or total knee
arthroplasty (THA or TKA) are a primary concern for surgeons and
can increase the cost and length of hospitalization, re-admission rates,
and incur additional surgeries. Such complications include a wide
range of conditions including bleeding, infection, and hemarthrosis.
The phase III RECORD program investigated the oral, direct Factor
Xa inhibitor rivaroxaban for the prevention of venous thromboembolism
after THA (RECORD1, 2) or TKA (RECORD3, 4). The
focus of this analysis from the pooled data from the four RECORD
studies was to investigate whether rivaroxaban regimens are similar
to enoxaparin regimens in the incidence of surgical complications
after THA and TKA.
Methods: Patients (N=12,729) were randomized to receive rivaroxaban
10 mg once daily for 35±4 days or enoxaparin 40 mg once
daily for 35±4 days (RECORD1) or 12±2 days followed by placebo
(RECORD2). In RECORD3 and 4 patients received prophylaxis for
12±2 days with rivaroxaban 10 mg once daily or enoxaparin 40 mg
once daily (RECORD3) or enoxaparin 30 mg twice daily
(RECORD4). Surgical safety outcomes were analyzed in the safety
population over the total treatment duration pool.
Results: The incidence of serious adverse events related to surgery,
such as post-procedural infection, operative hemorrhage, wound
dehiscence, postoperative wound infection, incision site hemorrhage,
and hemarthrosis, was similar in the rivaroxaban (30/6,183: 0.49%)
and enoxaparin (35/6,200: 0.56%) groups.
Conclusions: These data suggest that surgical safety outcomes
are unlikely to differ between rivaroxaban and enoxaparin
regimens.
S242
AGS 2012 ANNUAL MEETING