Association Of Geriatric Comanagement With Reduction In Adverse Surgical Outcomes Among Patients 75 Or Older With Cancer With Prolonged Hospital Stay.

12036 Background: Patients with prolonged hospital stay following surgery are at higher risk of readmission, emergency room visits, and mortality. In our study, we assessed the relationship between Geriatric Comanagement (GERI-CO) and adverse outcomes among these patients. Methods: In a retrospective study, patients aged 75+ with cancer who had hospital length of stay longer than 75% of cohort (8 days or longer) postoperatively at Memorial Sloan Kettering Cancer Center from 2011-18 were studied. GERI-CO status was obtained from medical records. Differences in sociodemographic, frailty, surgery, and comorbid conditions between GERI-CO and non-GERI-CO patients were assessed. Frailty was assessed by Memorial Sloan Kettering Frailty Index, score 0 to 11, higher score reflective of more frailty. Composite adverse outcome is a composite score of 30-day readmission, or emergency room visit, or 90 day mortality. Multivariable regression analysis was used to assess the relationship between GERI-CO and postoperative adverse outcome. Results: In total 1118 patients (634, 56.7% in the GERI-CO) were included. Patients in GERI-CO were older (80.8 vs. 79.9), more likely to undergo 3+ hours of surgery (66% vs. 43%), have 100+ cc intraoperative blood loss (78% vs. 72%), and have liver disease (16% vs. 10%), but were less likely to have kidney disease (19% vs. 25%), cardiac disease (28% vs. 35%), myocardial infarction (8% vs. 12%), pulmonary disease (15% vs. 20%), ASA-PS 4+ (11% vs. 21%) compared to non-GERI-CO patients. Gender, Frailty and the rest of comorbid conditions, and average length of stay (15 days) did not differ between groups. GERI-CO patients were less likely to have 30-day hospital admission (11% vs. 18%), emergency room visit (14% vs. 22%), or 90 day mortality (6% vs. 15%), and composite adverse outcome (20% vs. 37%) compared to non-GERI-CO patients. In the multivariable analysis, after adjustment for age, frailty, ASA-PS, operation time, intraoperative blood loss, kidney, cardiac and pulmonary disease, patients in GERI-CO were less likely to have composite adverse outcome (OR = 0.57, p = 0.002). Conclusions: GERI-CO program for patients with prolonged length of stay following surgery is associated with reduced 30-day hospital readmission, emergency room use, and 90-day mortality.