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11512 Background: We explored the association between geriatric comanagement and 90-day postoperative mortality of cancer patients aged 75 or older. Methods: A retrospective review of a prospectively maintained database was performed on patients over 75 years old who underwent elective surgery with hospital length of stay of ≥1 day at Memorial Sloan Kettering Cancer Center from 2015-2018. Geriatric comanagement group (GCG) patients had geriatric preoperative evaluation and inpatient geriatric comanagement. Patients in the surgical management group (SMG) did not have geriatric preoperative evaluation or postoperative geriatric comanagement. We utilized a multivariable logistic regression model with 90-day mortality as the outcome, geriatric co-management as the predictor, and adjusted for age, gender, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index, preoperative albumin level, operation time, and estimated blood loss. The same logistic model was used to assess the association between adverse surgical events within 30-days (any major complication, readmission, or urgent care center visit) and geriatric comanagement. Results: Of 1,855 patients (median age 80), 1,009 patients (54%) were co-managed by geriatricians. GCG patients were slightly older, less likely to be male, had longer operation time, and stayed in the hospital longer. Adjusted rates of 90-day mortality was lower in GCG vs. SMG (4.3% and 9.2%, respectively; 95% CI around difference -7.3%, -2.5%; p-value < 0.0001). We did not find evidence of a difference in adverse surgical events between groups (OR 0.96, p-value = 0.8). A greater proportion of GCG patients received inpatient physical therapy (80% vs. 64%) and occupational therapy (37% vs. 25%) compared to SMG patients. Conclusions: Our study shows that geriatric comanagement is associated with reduced 90-day postoperative mortality in cancer patients aged ≥75. A randomized trial study is needed to confirm this finding.

11542 Background: We have been prospectively collecting Geriatric Assessment (GA) data on patients aged 75+ undergoing oncologic surgery at a single institution. We aimed to to determine if a fitness scale based on a limited number of easily captured datafields can be developed, validated, and associated with 6 month postoperative mortality. Methods: From patients referred to Memorial Sloan Kettering (MSK) Geriatrics Service for preoperative GA since 2015, we have selected patients who were aged 75+, had elective surgery, with hospital length of stay (LOS) of ≥1 day, and had at least 6-month follow up. The Fitness Scale-4 item (FS4) is composed of 3 variables from the GA; Karnofsky Performance Scale (KPS), ability to walk outside, ability to perform housekeeping, and additional variable of preoperative albumin level. The FS4 total score ranges from 0-8 (frail = 0-2, vulnerable = 3-5, and fit = 6+). We validated this scale against prevalence of geriatric syndromes in each fitness category. We performed multivariable regression (MVR) analysis to assess the odds of six-month postoperative mortality among vulnerable and frail patients vs. fit patients. Results: Out of 1270 patients (median age 79, IQR 77-83), 792 (61.4%), 327 (25.7%) and 151 (11.9%) were fit, vulnerable, and frail, respectively. All of the geriatric syndromes were more prevalent among frail and vulnerable patients than fit patients. Six-month mortality rate was 4.7%, 12.5%, and 21.2% for fit, vulnerable, and frail patients, respectively. In the MVR analysis, and after adjustment for age, gender, ASA PS, LOS, operation time, KPS, and preoperative albumin, the odds of six-month mortality among frail (OR = 4.58, p = 0.004) and vulnerable patients (OR = 2.63, p = 0.004) vs. fit patients were much higher. Conclusions: Frail and vulnerable patients based on FS4 are at significantly higher risk for six-month postoperative mortality vs. fit patients. Future studies should assess the external validation of FS4, and its impact on surgical decision making, and perioperative care of older cancer patients.

172 Background: Older cancer patients are at higher risk for poor postoperative outcomes. We tested the validity and utility of Memorial Sloan Kettering-Frailty Index (MSK-FI) in this setting. Methods: In a single institution, prospective cohort study, patients age 75+ received comprehensive geriatric assessment (CGA) by the Geriatrics service during preoperative evaluation. The MSK-FI was developed based on the modified Frailty Index, incorporating 10 comorbid conditions and one item related to basic and instrumental activities of daily living. With the total score ranging from 0 to 11, a score of ≥ 3 was considered frail. We validated the MSK-FI against the CGA, and assessed the relationship between MSK-FI frailty with short term (hospital length of stay (LOS), intensive care unit (ICU) admission) and long-term (overall survival) postoperative outcomes utilizing multivariable linear, logistic, and cox regression models, adjusting for age, duration of surgery, American Society of Anesthesiologists physical status classification, and preoperative albumin level. Results: In total, 1,137 cancer patients (median age 80) were included in the study. The prevalence of frailty based on MSK-FI was 41%. Frail patients were more likely to have poor Karnofsky Performance Status (56% vs. 29%), be dependent in basic and instrumental activities of daily living (72% vs. 40% and 64% vs. 34%), experienced a fall in the past year (30% vs. 18%), have slower gait speed (49% vs. 22%),be depressed (66% vs. 49%), have limited social activity (62% vs. 43%), take ≥ 5 medications (63% vs. 25%), experienced significant weight loss (24% vs. 16%), and suffer from polycomorbid conditions (87% vs. 26%). Frailty was associated with longer LOS in the hospital (1.9 days, p

10035Background: Perioperative Geriatric Comanagement may improve surgical outcomes of older frail cancer patients. We present our 3 year experience with perioperative geriatric comanagement & the ...

10011Background: The relationship between age-related impairments in geriatric surgical patients and the need for postoperative intensive care unit (ICU) admission and subsequent outcomes is largel...

38 Background: Older cancer patients may need to make challenging treatment decisions at the time of preoperative evaluation. This study assesses the reasons and outcomes of older cancer patients who did not proceed with planned surgery. Methods: This is a retrospective analysis of a cohort of 1767 older cancer patients who presented to the Geriatrics clinic for preoperative evaluation between 1/2015 and 12/2016. Differences in Geriatric Assessment between those who proceeded and did not proceed with surgery were assessed within a month after preoperative evaluation. Charts of those who did not proceed with surgery were reviewed to identify the reasons, and outcomes of those patients. Results: In total, 114 out of 1767 (6.5%) did not proceed with surgery. Functional status played an important role in this decision. Among patients with Karnofsky Performance Scale (KPS) of 80+, 20% had their procedure in another institution; this was 0% for patients with KPS 70-. 61% of patients with KPS 50 opted for surveillance or supportive care, compared to 37% and 32% of those with KPS 60-70 and 80+, respectively. Reasons cited for not medically clearing the patients also differed. 60% and 69% of those with KPS 80+ and 60-70 were not cleared based on comorbid conditions, compared to 44% of those with KPS 50-. On the other hand, 44% of patients with KPS 50- had documented frailty as a reason for not getting clearance, compared to 15% and 23% of those with KPS 80+ and KPS 60-70. Conclusions: Geriatricians play an important role in helping patients reach proper medical decisions at the time of surgery. Future studies should look at various interventions that may assist older cancer patients/caregivers in their decision making at the time of surgery.