Geriatric-8 as a Predictor of Delirium and Postoperative Complication in Older Head and Neck Cancer.

Abstract

Predicting mortality and treatment-related adverse events in older patients undergoing surgical treatment for head and neck squamous cell carcinoma (HNSCC) remains a clinical challenge. We evaluated the utility of the Geriatric-8 (G8), a geriatric screening tool, in predicting delirium, postoperative complications, and prognosis. This single-institution retrospective study included 63 patients aged ≥ 70 years with HNSCC who underwent radical surgery between 2020 and 2022. The patients were stratified into low G8 (G8 score ≤ 14, n = 38) and high G8 (G8 score > 14, n = 25) groups. Incidence of delirium, postoperative complications, and overall survival (OS) were compared between the groups. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal G8 score thresholds for predicting delirium and postoperative complications. Delirium occurred significantly more frequently in the low G8 group than in the high G8 group (31.6% vs. 4.0%; p = 0.01). Similarly, postoperative complications were more common in the low G8 group compared to the high G8 group (31.6% vs. 4.0%; p = 0.01). The 3-year OS was 81.5% (95% CI: 63.0-91.4) in the low G8 group and 70.3% (95% CI: 32.2-89.6) in the high G8 group, with no significant difference (p = 0.649). The ROC analysis identified G8 cut-off values of 13.0 for predicting delirium (sensitivity: 84.6%, specificity: 68.0%) and 12.0 for predicting postoperative complications (sensitivity: 61.5%, specificity: 80.0%). Though not significant for OS, preoperative G8 assessment is useful in predicting delirium and postoperative complications for older patients with HNSCC.