Development and validation of a multivariable risk score for postoperative complications in urological surgery in older patients: FRAC cohort study.

The geriatric 8 score as a predictor of postoperative outcomes in elderly patients undergoing esophagectomy.

Preoperative health status assessed with different scales and postoperative cardiac and cerebrovascular complications in older patients: A retrospective study of a large multicentre cohort.

BACKGROUND Multiple scales are available to evaluate the health status of older surgical patients; however, their relative ability to predict postoperative major adverse cardiac and cerebrovascular events (MACCE) remains unclear. OBJECTIVE To examine the association between preoperative health status, as measured by four commonly used scales, and 30-day postoperative MACCE in older surgical patients, and to compare their predictive performance and incremental value against the Revised Cardiac Risk Index (RCRI). DESIGN A retrospective study of a large multicentre cohort. SETTING Nineteen tertiary hospitals across China participating in a perioperative database. PATIENTS Patients aged ≥65 years who underwent noncardiac, non-neurosurgical surgery between April 2020 and April 2022 were included in the analysis. The Activities of Daily Living (ADL), EuroQol Five-Dimension Five-Level (EQ-5D-5L), Metabolic Equivalent of Task (MET), FRAIL, and RCRI were evaluated preoperatively. MAIN OUTCOME MEASURE The primary outcome was the occurrence of MACCE within 30 days after surgery, defined as any of the following: stroke, myocardial infarction, angina pectoris, congestive heart failure, cardiac arrest, or all-cause mortality. RESULTS Among the 7996 patients, 126 (1.6%) experienced MACCE. Similar to the RCRI, the four health assessments were significantly associated with MACCE risk. The RCRI alone yielded an area under the curve (AUC) of 0.610 [95% confidence interval (CI): 0.563 to 0.658]. Incorporating each scale improved the predictive performance of the RCRI. The RCRI-Plus model, comprising RCRI, age, severity of anaemia, and surgical duration, achieved an AUC of 0.692 (95% CI: 0.643 to 0.741). Further addition of the four scales to the RCRI-Plus increased discrimination, with the highest AUC observed for the RCRI-Plus model incorporating FRAIL (AUC 0.724; 95% CI: 0.679 to 0.770). However, DeLong's test showed no significant differences between this model and the RCRI-Plus models incorporating ADL, EQ-5D-5L, or MET. CONCLUSIONS Preoperative health status assessed by four geriatric scales was significantly correlated with postoperative MACCE and provided improved risk discrimination beyond the RCRI. Adding any of these assessments to the RCRI enhanced predictive performance, with FRAIL showing the greatest incremental benefit. These findings underscore the value of multidimensional health status evaluation for preoperative cardiac and cerebrovascular risk stratification, with frailty assessment warranting particular attention. TRIAL REGISTRY ClinicalTrials.gov, NCT04911530.

Predictors of postoperative complications in elderly patients undergoing pulmonary lobectomy: a retrospective cohort study

Background Elderly patients undergoing pulmonary lobectomy for lung cancer are at increased risk of postoperative morbidity. Identifying modifiable risk factors and establishing a practical risk stratification method are essential for improving perioperative management. Methods This retrospective cohort study included 212 consecutive patients aged ≥65 years who underwent pulmonary lobectomy for non-small cell lung cancer from 2020 to 2024. Demographic, clinical, and surgical data were collected. The primary outcome was major postoperative complications (Clavien-Dindo grade ≥III). Independent predictors were identified using multivariable logistic regression, and a simplified risk score was constructed. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test. Results Major complications occurred in 73 patients (34.4%). Multivariable analysis identified three independent predictors: age ≥70 years (OR = 2.26, 95% CI: 1.18–4.42), Age-Adjusted Charlson Comorbidity Index (ACCI) ≥ 6 (OR = 3.70, 95% CI: 1.95–7.25), and preoperative hemoglobin <12 g/dL (OR = 3.04, 95% CI: 1.32–7.19). The multivariable model showed good discrimination (AUC = 0.712, 95% CI: 0.645–0.789) and calibration (Hosmer-Lemeshow p = 0.562). A simple risk score assigning one point per predictor demonstrated comparable discrimination (AUC = 0.699, 95% CI: 0.634–0.738) and a stepwise increase in complication rates: 26.0% (score 1), 54.7% (score 2), and 63.6% (score 3). Conclusion A risk score based on age ≥70 years, ACCI ≥6, and preoperative anemia effectively stratifies elderly patients by their risk of major complications after pulmonary lobectomy. This simple tool may facilitate preoperative counseling, guide targeted optimization, and inform perioperative resource allocation, though external validation is warranted.

A predictive tool incorporating frailty scores for perioperative risk assessment in patients with spinal metastasis: a national retrospective cohort study.

Integrating serum albumin, hematocrit, BMI, spinal region, and procedure type with frailty indices enhances risk stratification and informs surgical planning, preoperative optimization, and patient counseling in this vulnerable population of patients.

Elderly age and the risk of postoperative complications in elective abdominal surgery: results of the multicenter study STOPRISK

INTRODUCTION: Older age is recognized as an independent risk factor for adverse perioperative outcomes; however, quantitative data on the impact of early old age (65–75 years) on 30-day postoperative complications in a multicenter Russian cohort are lacking. OBJECTIVE: To determine whether older age (65–75 years) is associated with the incidence, pattern, severity, and timing of 30-day postoperative complications and mortality compared with patients aged 18–64 years undergoing elective abdominal surgery. MATERIALS AND METHODS: A multicenter prospective cohort study was conducted (secondary analysis of the STOPRISK database, NCT03945968; STROBE). From 2019 to 2024, 12,000 patients from 38 centers across the Russian Federation were enrolled. After exclusions, the analytical sample comprised 10,915 patients: 18–64 years (n = 8,119) and 65–75 years (n = 2,796). The primary outcome was any 30-day postoperative complication (ESA/ESICM). Secondary outcomes were 30-day mortality, complication severity (Clavien-Dindo), and timing of occurrence. RESULTS: The 30-day complication rate in patients aged 65–75 years was more than twice that in the 18–64-year group (7.15 vs 3.09 %), and 30-day mortality was more than threefold higher (1.18 vs 0.33 %). The greatest relative risk increase was observed for postoperative delirium (RR 7.55), acute myocardial infarction (RR 5.08), arrhythmias (RR 4.26), and acute kidney injury (RR 3.87). The distribution of complication severity according to Clavien-Dindo did not differ between groups, most complications in both groups occurred within the first 5 days. After multivariable adjustment, older age remained an independent predictor of any complications, severe complications, and mortality. CONCLUSIONS: Older age (65–75 years) is an independent predictor of postoperative complications and mortality following elective abdominal surgery, increasing the risk of complications 1.7-fold and the risk of death 2.2-fold after confounder adjustment. The identified profile of high-risk specific complications supports the need for targeted perioperative management protocols in elderly patients.

Comparative Analysis of the ASA-PS Score and Clinical Frailty Scale in Predicting Postoperative Intensive Care Unit Requirement in Geriatric Hip Fracture Surgery: A Retrospective Evaluation

In this study, ASA-PS and CFS demonstrated comparable performance in predicting ICU admission; however, neither scale retained independent predictive value after adjustment for age, coronary artery disease, and type of anesthesia.