Utility of Geriatric Focused Preoperative Assessment in Predicting Postoperative Complications and Outcomes
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background Background: With Japan' s rapidly aging population, the number of older adults undergoing surgery continues to rise.The American Society of Anesthesiologists Physical Status (ASA-PS) classification, widely used for preoperative evaluation, does not fully capture the heterogeneity and complexity of this population.Several studies have suggested that ASA-PS is not strongly correlated with postoperative complications or long-term outcomes in older adults.In contrast, Comprehensive Geriatric Assessment (CGA) has gained attention as a tool to better evaluate this population, particularly as preoperative physical function decline is associated with poor outcomes.We developed a novel Geriatric Perioperative Risk Assessment (GPRA) tool that combines CGA elements with physical function measures and examined its association with postoperative complications and outcomes.Methods Methods: We retrospectively analyzed 101 consecutive patients aged 70 years or older who underwent elective surgery at our hospital between April 2022 and September 2024 (59 for gastrointestinal diseases, 42 for cardiovascular diseases).The assessment included the key CGA components of the Mini-Mental State Examination and the 15-item Geriatric Depression Scale -Short Form, along with physical function measured by the Five-Times Sit-to-Stand Test.Outcomes included the length of hospital stay, the incidence of postoperative delirium (POD) and other complications, discharge disposition (to home or transfer to another facility), and one-year postoperative mortality.Associations between outcomes and our GPRA system were compared with those of ASA-PS.〈Regular Article〉 188 Kawasaki Medical Journal models incorporate elements such as nutritional status and comorbid conditions, they still fall short in addressing the full complexity of aging.Recently, geriatric assessment, and especially Comprehensive Geriatric Assessment (CGA), has gained attention as a means of evaluating the multidimensional characteristics of older patients ６) .CGA assesses a range of domains, including physical function, cognitive ability, nutritional status, and psychological well-being, and has been shown to be associated with the incidence of postoperative delirium (POD), other complications, and short-term outcomes ７， ８) .In gastrointestinal surgery, studies have identified cognitive decline and depressive symptoms as risk factors for POD ９) , and CGA has demonstrated stronger prognostic value than age or performance status ６) .Nishizawa et al. reported in their study on laparoscopic surgery for older colon cancer patients that a classification system combining MMSE, GDS, and lower limb muscle strength was associated with POD risk 10) .In the field of cardiovascular surgery, it has been reported that depressive symptoms in older adults significantly increase the risk of both all-cause mortality and cardiovascular mortality 11) .However, CGA is not yet widely adopted as a Results Results: The mean age of participants was 78.4 ± 5.8 years; 56% were male, and the mean BMI was 22.0 ± 3.5 kg/㎡ .POD occurred in 9 cases.Complications classified as Clavien-Dindo grade Ⅱ or higher occurred in 47% of patients.Among the 101 patients, 84 were discharged to their home and 17 were transferred to another facility.Five patients died within one year of their surgeries.The GPRA tool was significantly associated with POD (p < 0.01) and discharge outcome (p < 0.05).In contrast, ASA-PS was associated with prolonged hospitalization (p < 0.05) and non-delirium complications (p < 0.05).Conclusion Conclusion: Geriatric Perioperative Risk Assessment incorporating cognitive, psychological, and physical function measures may help predict postoperative delirium and discharge outcomes in older adults.Integrating CGA components into routine preoperative evaluations may support the development of preventive strategies and improve perioperative recovery in older patients.
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7162266200