Pre-surgical Geriatric Syndromes, Frailty, and Risks for Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: Prevalence and Red Flags

Objective: We sought to identify and evaluate red flags for pre-surgical geriatric conditions (geriatric syndromes, frailty, and risks for postoperative delirium) in older patients undergoing gastrointestinal surgery. Methods: Older individuals (?65?years) undergoing major elective gastrointestinal surgery from 2009 to 2012 were enrolled and assessed preoperatively. Results: Participants (N = 379; mean age = 74.5 ± 5.9?years) primarily underwent colorectal (54.3?%), gastric (21.9?%), and pancreatobiliary (12.6?%) surgery. Overall, 30.9?% had existing geriatric syndromes, 26.7?% were frail, and 22.8?% had >3 risk factors for postoperative delirium. The largest proportion (45.7?%) presented with at least one geriatric condition. Patients with or without geriatric conditions were discriminated with adequate sensitivity (67?%), specificity (84?%), and positive predictive value (77?%) by eight red flags: age ?75?years (OR, 2.86; P < 0.001), eating soft food (OR, 3.63; P = 0.001), reported hypertension (OR, 2.8; P = 0.001), weight loss >3?kg (OR, 4.79; P < 0.001), fair-to-weak grip strength (OR, 2.53; P = 0.001), sleeplessness (OR, 2.57; P = 0.001), no-better-than-peer perceived health (OR, 1.88; P = 0.022), and short-term inability to recall two of three common words (OR, 1.81; P = 0.025). Conclusions: Eight red flags covered as part of history and physical examination are well suited to screen patients for geriatric conditions indicating the need for preoperative geriatric assessments and optimization. ? 2015, The Society for Surgery of the Alimentary Tract.