Benchmarking risk prediction tools in spine surgery: a national registry analysis of albumin, frailty, and surgical calculators.

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.

Utility of the Clinical Frailty Scale, Charlson Comorbidity Index and ACS NSQIP Surgical Risk Calculator in major lower limb orthopaedic surgery.

BACKGROUND With major lower limb orthopaedic surgery performed in increasingly older and comorbid patients, accurate risk prediction is essential to guide perioperative management and shared decision-making. AIMS To compare the Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP Calculator) in predicting complications following major lower limb orthopaedic surgery. METHODS We conducted an audit assessing the clinical utility of the CFS, CCI and ACS NSQIP Calculator at an Australian tertiary hospital (2023-2024). Scores were calculated retrospectively using admission documentation, and complications were identified prospectively. RESULTS We recruited 302 patients with a mean age of 75.1 ± 12.7 years. Patients underwent surgery for hip fracture (n = 100), elective total knee (n = 103) and hip (n = 69) arthroplasty and other indications (n = 30). During index hospitalisation, 27.5% (n = 83) experienced a serious complication (Clavien-Dindo Grade ≥ II). All tools demonstrated moderate discrimination for serious in-hospital complications; the CFS, CCI and ACS NSQIP Calculator had area under the receiver operating characteristic curves of 0.77 (95% confidence interval (CI) 0.71-0.83), 0.71 (95% CI 0.64-0.77) and 0.76 (95% CI 0.70-0.82) respectively. The CFS was the fastest tool to administer, and the ACS NSQIP Calculator was the most time-consuming (median time 9.5 s (interquartile range (IQR) 7-13) vs 98.5 s (IQR 73-165), P < 0.001). CONCLUSION The CFS and ACS NSQIP Calculator demonstrated similar predictive performance in this cohort. Given its faster administration, the CFS may represent a practical tool for routine perioperative risk stratification, though prospective validation is required to confirm performance in real-time clinical workflows.

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

A multivariable risk score incorporating SPPB alongside key clinical variables predicts 30-day postoperative complications in older urological patients and provides valuable objective frailty assessment for preoperative risk stratification.

TPTh 3.02 Perioperative Risk Prediction in Emergency Laparotomy: Evolution, Current Tools and Future Directions

Emergency laparotomy (EL) is a high-risk general surgical procedure, increasingly performed in frail, comorbid populations. Over the past seven decades, multiple risk stratification tools have emerged to quantify perioperative risk, incorporating physiological parameters, comorbidities, and, in some cases, anticipated operative findings. This review synthesises the historical evolution and current utility of these tools in EL, highlighting their roles in shared decision-making, consent, and quality improvement. Risk prediction in EL has progressed from early physiological scores (ASA, APACHE) to audit-derived models (POSSUM, P-POSSUM), large database-driven calculators (ACS-NSQIP), and EL-specific tools such as NELA, ESAS/PESAS, ESS and CORES. Disease-specific indices (e.g., Mannheim Peritonitis Index) and emerging prognostic markers, including frailty measures and CT-derived body-composition metrics, address limitations of traditional physiological models, particularly in elderly or physiologically vulnerable patients. Tools based solely on preoperative variables support rapid assessment when operative data are unavailable, whereas newer early-mortality scores (e.g., CELIO) may aid proportionality and goals-of-care discussions but require further validation. A chronological table summarises each scoring system’s variables and development timeline. Risk-adjusted outcomes should replace crude mortality as the benchmark for surgical quality, consent, and institutional comparison. Integrating validated scoring systems with frailty, physiological variables and body composition assessment offers a pragmatic framework for individualised care, especially in older, comorbid patients. This approach supports standardisation, reduces unwarranted variation, and guides future research toward improved calibration and external validation. Clinically, these tools enhance transparency, facilitate multidisciplinary communication, and align surgical decision-making with patient-centred and evidence-based principles.

Assessing Pediatric Frailty: Use of the Surgical Complication Index for Pediatric Patients (SCIPP) Score to Predict Adverse Outcomes Following Thoracic Surgery.

INTRODUCTION The Surgical Complication Index for Pediatric Patients (SCIPP) score, validated for use in pediatric neurosurgery, assesses seven components of frailty for a composite score: independence in performing activities of daily living (ADLs), autonomic function, body mass index (BMI), continence, previous admissions, mobility, and polypharmacy, while a reduced SCIPP score utilizes ADLs, autonomic function, and polypharmacy components. This study aimed to understand the predictive performance of full and reduced SCIPP score in children undergoing thoracic operations. METHODS A single-center retrospective review of patients age 2-18 years undergoing thoracic surgery from 2020-2025 was conducted, excluding patients with missing components of SCIPP score. Full and reduced SCIPP scores were calculated. Operative details and postoperative outcomes with 1-month follow-up were collected. Multiple logistic regression assessed the association between SCIPP scores, complications, and length of stay (LOS). RESULTS We included 317 patients. SCIPP scores were 0-1 in 70.7%, 2-3 in 18.0%, and 4+ in 11.4%. Logistic regression found that for every 1-point increase in full and reduced SCIPP scores, patients were 2.19 and 3.24 times more likely to have any complication, respectively (p<0.001). LOS increased by 26% for each point greater in full SCIPP score and 44% for reduced SCIPP score (p<0.001). CONCLUSION The SCIPP score, a composite pediatric frailty index, can predict a patient's risk of complications and likelihood of increased LOS following thoracic surgery. There is a role for SCIPP score utilization, particularly the reduced score, in the preoperative setting to optimize parental counseling, risk assessment, and determination of prehabilitation needs.

Predictive value of the 5-factor modified frailty index for pneumonia in older adults with cervical spinal cord injury.