Perception of postoperative functional status in gastrointestinal and hepatobiliary cancer patients over 80.

Abstract

11117 Background: Advanced age independently predicts poor surgical outcomes in cancer patients, making octogenarians a particularly high-risk surgical population. Improvement in the delivery of care to these vulnerable patients is critical to improve not only morbidity and mortality outcomes, but also patient-centered outcomes such as functional status. Postoperative functional outcomes can be evaluated by subjective perception and quantified performance. The aims of this study were to 1) identify risks associated with 30-day postoperative perceptions of functional decline in octogenarians undergoing operations for gastrointestinal or hepatobiliary cancers and 2) explore whether these perceptions correlate with quantitative decline measured as a function of decreased ability to perform activities of daily living (ADLs). Methods: American College of Surgeons National Surgical Quality Improvement Program Geriatric Surgery data (2015-2017) was used. All postoperative diagnoses related to gastrointestinal or hepatobiliary cancers were included for patients ≥80 years old. Multivariable logistic regression models identified risks associated with perceiving worsened physical function 30-days postoperatively. Chi-square tests were used to examine concordance between 30-day outcomes of perceptions of physical function with measured performance of ADLs. Results: 369 patients from 14 hospitals were included. Mean age was 85.4 (SD 4.1 years). The most common diagnosis was “malignant neoplasm of ascending colon” (16%). Preoperatively 62% of patients were living supported at home, 37% were using a mobility aid, and 17% had ≥1 fall in the past year. Overall, 80% did not have a quantified decline in function as measured by ADLs; however, 17% of these reported perceived functional decline (K= 0.47). Significant risk factors for perceived functional decline were major postoperative morbidity (OR 5.5; 95% CI 2.3-13), disseminated cancer (2.2; 1.1-4.4), new postoperative mobility aid use (2.2; 1.1-4.6), and cognitive impairment (4.7; 1.7-12.9). Conclusions: There are inconsistencies between patient experience and clinician view of functional outcomes for octogenarians undergoing surgical intervention for gastrointestinal and hepatobiliary cancers. Ability to perform ADLs is frequently used to evaluate patient functional status. This discrepancy in patient perception and quantified measure highlights the need for the development and utilization of patient-centered and patient-reported outcome (PRO) measures to evaluate this vulnerable patient population. PROs may enhance surgeon understanding of the patient experience and allow for more nuanced goals of care discussions and targeted interventions to improve delivery of care to these patients. Patient Reported Functional Decline Quantified Functional Decline No Yes Total No 246 22 268 Yes 49 52 101 Total 295 74 369