• Cheryl Chia-Hui Chen, Ming-Tsan Lin, Jin-Tung Liang, Chun-Min Chen, Chung-Jen Yen, and Guan-Hua Huang.
• Department of Nursing, College of Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan, cherylchen@ntu.edu.tw.
• J. Gastrointest. Surg. 2015 May 1;19(5):927-34.

ObjectiveWe 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.MethodsOlder individuals (≥65 years) undergoing major elective gastrointestinal surgery from 2009 to 2012 were enrolled and assessed preoperatively.ResultsParticipants (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).ConclusionsEight 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.

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