ABSTRACT Background Preoperative risk assessment is particularly crucial in elderly patients, who often present with comorbidities and organ dysfunction. We investigated the utility of Dementia Assessment Sheet for Community‐based Integrated Care System 21‐items (DASC‐21) in predicting postoperative pneumonia in elderly patients undergoing esophagectomy for esophageal cancer. Patients and Methods We retrospectively analyzed 60 patients aged ≥ 75 years who underwent esophagectomy for esophageal cancer between May 2019 and March 2025 at Wakayama Medical University Hospital. The DASC‐21 assessment was conducted for all patients aged 75 years or older who were admitted to our hospital before the esophagectomy. Results Postoperative pneumonia classified as Clavien‐Dindo grade ≥ 2 occurred in 13 patients of all the 60 patients (21.7%). Receiver operating characteristic (ROC) curve analysis using postoperative pneumonia as the event showed that the optimal cutoff value of the DASC‐21 score was 26 points. Fourteen elderly patients had DASC‐21 high scores and 46 had low scores. Patients with high DASC‐21 scores had significantly poorer performance status. The DASC‐21 high score group had a higher incidence of postoperative pneumonia than the DASC‐21 low score group (50.0% vs. 13.0%; p = 0.003). Furthermore, the DASC‐21 high score group tended to have a higher transferring rate to other hospitals than the low score group (42.9% vs. 19.6%; p = 0.078). Older age (≥ 78 years old), poor performance status, comorbidity of diabetes mellitus, and DASC‐21 high score were suggested as risk factors for postoperative pneumonia by univariate analysis. Conclusions The preoperative DASC‐21 high score was significantly associated with the occurrence of postoperative pneumonia in elderly patients undergoing esophagectomy for esophageal cancer.
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