valoración geriátrica integral en pacientes de edad avanzada con patología benigna hepatobiliopancreática

Abstract

Introduction: It is increasingly common to observe the tendency of societies to have increasingly longer-lived individuals, and it is evident that there is a growing global life expectancy in the Western world. Epidemiological profiles are changing daily, and some age-related diseases are becoming more prevalent. The Comprehensive Geriatric Assessment (CGA) allows us to address the confluence of different factors contributing to older adults' clinical complexity. This study was designed to analyze the clinical utility of comprehensive geriatric assessment on the clinical outcomes of managing benign hepatobiliary and pancreatic diseases in elderly patients. Methods: A prospective observational study was carried out that included a total of 140 elderly patients (over 75 years old) diagnosed with benign hepatobiliary-pancreatic disease. The patients were divided into three groups according to age: Group 1: 75-79 years; Group 2: 80-84 years old; Group 3: 85 years and older. A comprehensive geriatric assessment was performed with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Frailty Scale, upon admission and at follow-up 90 days after hospital discharge, to analyze its influence on morbidity, hospital stay, and complications: surgeries and mortality. Results: No statistically significant differences were found between patients treated conservatively or those who underwent surgery, regardless of age. No statistically significant differences were found between patients treated conservatively or those who underwent surgery, irrespective of the scales used, except for the Barthel index (p=0.001). Regarding complications in the different age groups, there are statistically significant differences (p=0.033) globally, with Grade I complications occurring mainly in the three age groups in practically equal percentages. In patients with a Barthel ≤ 60, these patients with a lower Barthel score had more significant complications. (p=0.037). Conclusions: • The Barthel index and the Charlson index are the most appropriate scales in the Comprehensive Geriatric Assessment to assess the risk of mortality and morbidity in elderly patients with benign hepatobiliary-pancreatic pathology. • In elderly patients with benign hepatobiliary-pancreatic pathology, the decision on the best therapeutic option is not conditioned by age. • Although an association has not been established between the Comprehensive Geriatric Assessment and the therapeutic option offered to patients, in general terms it can be observed that, despite advanced age, mortality in surgical patients was much lower than in those who received medical treatment. Therefore, a multidisciplinary approach is necessary to agree on lines of action that directly improve the diagnosis, treatment and quality of life of this population.

Date of Award	26 Nov 2024
Original language	Spanish
Supervisor	David Pares Martinez (Director), Manel Cremades Perez (Director) & Vivian Vilchez Barboza (Director)