Pasquale Abete1, Antonio Cherubini2, Mauro Di Bari3, Carlo Vigorito4, Giorgio Viviani5, Niccolò Marchionni3, Daniele D'Ambrosio4, Alessandro Golino4, Rocco Serra6, Elena Zampi6, Ilaria Bracali3, AnnaMaria Mello3, Alessandra Vitelli4, Giuseppe Rengo7, Francesco Cacciatore7, Franco Rengo7. 1. Dipartimento di Scienze Mediche Traslazionali, Università di Napoli "Federico II", Via S. Pansini, n°5, 80136 Napoli, Italy. Electronic address: p.abete@unina.it. 2. Geriatria ed Accettazione Geriatrica d'urgenza, IRCCS-INRCA, Ancona, Italy. 3. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 4. Dipartimento di Scienze Mediche Traslazionali, Università di Napoli "Federico II", Via S. Pansini, n°5, 80136 Napoli, Italy. 5. Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy. 6. Sezione di Gerontologia e Geriatria, Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy. 7. Fonadazione Salvatore Maugeri IRCCS Istituto Scientifico di Telese, Benevento, Italy.
Abstract
BACKGROUND: The evaluation of surgical risk is crucial in elderly patients. At present, there is little evidence of the usefulness of comprehensive geriatric assessment (CGA) as a part of the overall assessment of surgical elderly patients. METHODS: We verified whether CGA associated with established surgical risk assessment tools is able to improve the prediction of postoperative morbidity and mortality in 377 elderly patients undergoing elective surgery. RESULTS: Overall mortality and morbidity were 2.4% and 19.9%, respectively. Multivariate analysis showed that impaired cognitive function (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.15 to 4.22; P < .02) and higher Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (OR, 1.11; 95% CI, 1.00 to 1.23; P < .04) are predictive of mortality. Higher comorbidity is predictive of morbidity (OR, 2.12; 95% CI, 1.06 to 4.22; P < .03) and higher American Society of Anesthesiologists (OR, 2.18; 95% CI, 1.31 to 3.63; P < .001) and National Confidential Enquiry into Patient Outcome of Death score (OR, 2.03; 95% CI, 1.03 to 4.00; P < .04). CONCLUSIONS: In elective surgical elderly patients, the morbidity and mortality are low. The use of CGA improves the identification of elderly patients at higher risk of adverse events, independent of the surgical prognostic indices.
BACKGROUND: The evaluation of surgical risk is crucial in elderly patients. At present, there is little evidence of the usefulness of comprehensive geriatric assessment (CGA) as a part of the overall assessment of surgical elderly patients. METHODS: We verified whether CGA associated with established surgical risk assessment tools is able to improve the prediction of postoperative morbidity and mortality in 377 elderly patients undergoing elective surgery. RESULTS: Overall mortality and morbidity were 2.4% and 19.9%, respectively. Multivariate analysis showed that impaired cognitive function (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.15 to 4.22; P < .02) and higher Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (OR, 1.11; 95% CI, 1.00 to 1.23; P < .04) are predictive of mortality. Higher comorbidity is predictive of morbidity (OR, 2.12; 95% CI, 1.06 to 4.22; P < .03) and higher American Society of Anesthesiologists (OR, 2.18; 95% CI, 1.31 to 3.63; P < .001) and National Confidential Enquiry into Patient Outcome of Death score (OR, 2.03; 95% CI, 1.03 to 4.00; P < .04). CONCLUSIONS: In elective surgical elderly patients, the morbidity and mortality are low. The use of CGA improves the identification of elderly patients at higher risk of adverse events, independent of the surgical prognostic indices.