What is the clinical evidence from this study?

Study design: Cohort. Population: Elective non-cardiac surgery (n=2878). Intervention: Elective non-cardiac surgery. Primary outcome: Disability-free survival (DFS).

What question did this study set out to answer?

This research aims to assess the prevalence of disability-free survival five years after elective non-cardiac surgery and identify associated preoperative factors.

May 11, 2026

Prevalence of disability-free survival at 5 years after surgery: a prospective observational study

Resultado clave

Elective non-cardiac surgery in older adults resulted in an 80.6% rate of disability-free survival at 5 years, with older age (OR 1.76) and symptomatic cerebrovascular disease (OR 1.94) reducing DFS.

Puntos clave

This research aims to assess the prevalence of disability-free survival five years after elective non-cardiac surgery and identify associated preoperative factors.
Prospective cohort study with 2878 patients aged ≥55 years
Follow-up of 5 years post-elective non-cardiac surgery
Utilized multivariable logistic regression and machine learning for analysis.
80.6% (n = 2321) of patients achieved disability-free survival at 5 years
Factors associated with non-disability-free survival included older age (OR: 1.76) and malignancy (OR: 1.53)
Machine learning models achieved a balanced accuracy of 0.69 and AUC of 0.76.

Diseño del estudio

Tipo

Cohort (n=2,878)

Multicéntrico

PICO estructurado

Población

2878 patients aged ≥55 years who underwent elective non-cardiac surgery under general anesthesia between 2016 and 2018

Intervención

Elective non-cardiac surgery under general anesthesia

Resultado

Disability-free survival (DFS) at 5 years, defined as survival without significant functional disability assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)composite

In older adults undergoing elective non-cardiac surgery, over 80% achieved disability-free survival at 5 years, which can be moderately predicted using preoperative factors and machine learning models.

Resumen

PURPOSE: To determine the prevalence of disability-free survival (DFS) five years after elective non-cardiac surgery in older adults, and to identify preoperative factors associated with DFS using conventional statistical analyses and machine learning methods. METHODS: In this prospective cohort study conducted at a single tertiary hospital in Japan, 2878 patients aged ≥55 years who underwent elective non-cardiac surgery under general anesthesia between 2016 and 2018 were enrolled and followed for 5 years. DFS was defined as survival without significant functional disability, assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Multivariable logistic regression and machine learning models were used to identify preoperative predictive factors. RESULTS: At 5 years after surgery, 80.6% (n = 2321) of the patients achieved DFS. Factors significantly associated with non-DFS included older age (odds ratio OR: 1.76), symptomatic cerebrovascular disease (OR: 1.94), low serum albumin (OR: 0.70), poor nutritional status (OR: 0.80), and malignancy (OR: 1.53). The machine learning ensemble model, incorporating support vector machine, neural network, and XGBoost algorithms, achieved a balanced accuracy of 0.69 and an area under the receiver operating characteristic curve (AUC) of 0.76. CONCLUSION: Multiple preoperative factors were independently associated with long-term DFS after surgery. Machine learning methods demonstrated moderate predictive accuracy, indicating potential clinical utility pending further model refinement.

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