B54-30 Functional Capacity as a Predictor of Intraoperative Arrhythmia and Mortality in Surgical Patients Aged Ninety Years and Older

Rationale Older adults experience higher perioperative risk due to reduced physiological reserves and impaired compensatory mechanisms. The New York Heart Association (NYHA) classification is widely used to assess cardiac functional capacity but has limited validation for predicting surgical risk in very elderly patients. Nonagenarians, in particular, represent a growing yet understudied population in perioperative medicine. This study aimed to evaluate whether preoperative NYHA class is associated with intraoperative events and postoperative outcomes in surgical patients aged 90 years or older. Methods We conducted a retrospective cohort study including patients aged ≥90 years who underwent any surgical procedure in Colombia between January 2020 and December 2024. NYHA class was recorded as an indicator of preoperative cardiac function. Associations were evaluated between NYHA class (I-II vs. III-IV) and intraoperative events—arrhythmia, desaturation, hypotension, bleeding, and perioperative ischemia—as well as postoperative outcomes including complications, delirium, infection, readmission, length of hospital stay, and in-hospital mortality. Comparisons were performed using Chi-square and Mann-Whitney U tests, with statistical significance set at p < 0.05. Results A total of 206 surgical patients aged ≥90 years were analyzed. Higher NYHA class (III-IV) was significantly associated with an increased incidence of intraoperative arrhythmia (p = 0.007) and in-hospital mortality (p = 0.029). No statistically significant associations were observed between NYHA class and other intraoperative events (hypotension, desaturation, bleeding, or ischemia) or postoperative outcomes such as delirium, infection, complications, or prolonged hospitalization. These findings suggest that reduced functional capacity, as reflected by higher NYHA class, predisposes patients to intraoperative cardiac instability and early mortality. Conclusions Preoperative NYHA classification serves as a simple and clinically meaningful predictor of intraoperative arrhythmia and in-hospital mortality among surgical patients aged ninety years and older. Incorporating NYHA class into routine preoperative assessments may improve identification of high-risk individuals and guide perioperative planning, including enhanced intraoperative cardiac monitoring and tailored hemodynamic strategies. Future research should assess its predictive performance in combination with frailty and comorbidity indices to refine geriatric surgical risk models. REFERENCES: 1. Goudie RJ, Baharani J, Davis P, Dhesi JK. Risk prediction models for perioperative complications in older surgical patients: a systematic review. Anaesthesia. 2019;74(4):427-436.