Perioperative Adverse Events in Geriatric Patients: A Comparison of the Predictive Abilities of Three Preoperative Scores

TL;DR

This study compares three preoperative scores to see which best predicts complications in elderly patients undergoing surgery.

Contribution

The study evaluates and compares the predictive accuracy of three preoperative risk scores in geriatric surgical patients.

Findings

The Lee Cardiac Index had the highest predictive accuracy (AUC 0.85) for perioperative adverse events.

Duration of surgery and hospital stay were longer in patients with adverse events.

Age was not a significant predictor of perioperative complications in this geriatric group.

Abstract

Introduction

Geriatric patients are increasingly presenting for surgery globally. This study aimed to compare three preoperative scoring systems in their ability to predict perioperative outcomes in geriatric patients who underwent surgical intervention at a tertiary care teaching hospital.

Methods

A retrospective chart review was done to include geriatric patients (65 years and above) undergoing various surgical procedures. American Society of Anesthesiologists (ASA) Physical Status Grades, Revised Lee Cardiac Risk index, and Generic Scores were assigned to all patients. Demographic data and clinical data including preoperative clinical parameters, the procedure, type and duration of anesthesia, surgical specialty, blood loss, intraoperative and postoperative events, length of stay, postoperative events and survival were recorded. The three scores were compared regarding their ability to predict perioperative adverse events.

Results

Fifty-four patients were included in the study. The ages ranged from 65 to 87 years (Mean 73.5, 5.8 SD). Females were the majority of patients (64.8%). Patients belonged to general surgery, urology, and thoracic surgery. About 7.4% of the patients developed postoperative events requiring ICU admission. Within the geriatric range, age was not a significant factor impacting perioperative adverse events. Duration of surgery, anesthesia, and hospital length of stay were significantly higher in patients who had perioperative adverse events. With respect to discriminant ability for predicting perioperative adverse events, the area under the Receiver Operating Curve for Lee Cardiac Index was 0.85, 0.67 for the Generic Score, and 0.62 for ASA Physical Status Grades.

Conclusion

With the limitation of a small sample size, within the patients studied, the revised Lee Cardiac Risk Index was able to predict immediate perioperative adverse events better when compared to the ASA Physical Status Grades and a Generic Score in geriatric patients.

Figures