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A promising new strategy for making an objective diagnosis of dietary patterns that indicate a risk for malnutrition is urine metabolomics analysis. The identification of malnutrition often relies on clinical screening tools that are reliant on various amounts of subjective recall. In patients undergoing major abdominal surgery, malnutrition is associated with worse outcomes, including increased lengths of stay, increased in-hospital mortality rates, and higher costs of care. Malnutrition refers to deficiencies, imbalances, or excesses in a person’s intake of energy and nutrients. Sarcopenia has been associated with an increased risk of postoperative complications in patients undergoing gastrointestinal tumor resection, and it has a potential role in preoperative risk stratification if both muscle mass and function are assessed. Muscle function is often measured through hand grip strength, while lower extremity and torso muscle mass can be evaluated through numerous mechanisms, including computerized tomography (CT) morphometric analysis. It is also associated with malnutrition, although the two entities can occur separately. It is often associated with physical frailty, yet being clinically frail is not always a prerequisite for a sarcopenia diagnosis. Sarcopenia is the age-related loss of muscle mass and function. Each of these assessments can be rapidly performed and have been validated with multiple cohorts. Two simple-to-use frailty assessments are the Clinical Frailty Scale (CFS) and the Groningen Frailty Indicator (GFI). Frailty is also associated with an increased cost of elective surgical care. Regardless of the definition used, preoperative frailty has been shown to be associated with poor postoperative outcomes in major colorectal surgery, such as an increased number of postoperative complications, an increased length of hospital stay, higher readmission rates, and decreased long-term survival rates. There are numerous definitions, which vary from clinical phenotypes with specific required criteria to operational definitions (eg, the tally of an accumulation of deficits in older patients). FrailtyĪt present, while there are no universally agreed upon consensus criteria for defining frailty, it can be thought of as physiologic decline and an increased risk of poor health resulting from aging. Although each has been studied individually, there is little information on their associations in older surgical patients. Further, three of the most important age-related preoperative factors in older surgical patients are frailty, sarcopenia, and malnutrition.
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This makes it important to understand surgical risk factors in older adults and implement timely intervention where possible. As populations continue to age, the incidence of major colon and rectal resections for cancer in the older population are projected to increase dramatically.
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The majority of colorectal cancers are still diagnosed after the age of 65 years. This is particularly important in the context of colorectal cancers, which are the third most diagnosed malignancy and the fourth leading cause of cancer death worldwide. In particular, older patients undergoing surgery have age-related factors that can affect their surgical outcomes. There are numerous preoperative factors that affect surgical patients.