Preoperative health status assessed with different scales and postoperative cardiac and cerebrovascular complications in older patients

BACKGROUND: Multiple scales are available to evaluate the health status of older surgical patients; however, their relative ability to predict postoperative major adverse cardiac and cerebrovascular events (MACCE) remains unclear. OBJECTIVE: To examine the association between preoperative health status, as measured by four commonly used scales, and 30-day postoperative MACCE in older surgical patients, and to compare their predictive performance and incremental value against the Revised Cardiac Risk Index (RCRI). DESIGN: A retrospective study of a large multicentre cohort. SETTING: Nineteen tertiary hospitals across China participating in a perioperative database. PATIENTS: Patients aged ≥65 years who underwent noncardiac, non-neurosurgical surgery between April 2020 and April 2022 were included in the analysis. The Activities of Daily Living (ADL), EuroQol Five-Dimension Five-Level (EQ-5D-5L), Metabolic Equivalent of Task (MET), FRAIL, and RCRI were evaluated preoperatively. MAIN OUTCOME MEASURE: The primary outcome was the occurrence of MACCE within 30 days after surgery, defined as any of the following: stroke, myocardial infarction, angina pectoris, congestive heart failure, cardiac arrest, or all-cause mortality. RESULTS: Among the 7996 patients, 126 (1.6%) experienced MACCE. Similar to the RCRI, the four health assessments were significantly associated with MACCE risk. The RCRI alone yielded an area under the curve (AUC) of 0.610 [95% confidence interval (CI): 0.563 to 0.658]. Incorporating each scale improved the predictive performance of the RCRI. The RCRI-Plus model, comprising RCRI, age, severity of anaemia, and surgical duration, achieved an AUC of 0.692 (95% CI: 0.643 to 0.741). Further addition of the four scales to the RCRI-Plus increased discrimination, with the highest AUC observed for the RCRI-Plus model incorporating FRAIL (AUC 0.724; 95% CI: 0.679 to 0.770). However, DeLong's test showed no significant differences between this model and the RCRI-Plus models incorporating ADL, EQ-5D-5L, or MET. CONCLUSIONS: Preoperative health status assessed by four geriatric scales was significantly correlated with postoperative MACCE and provided improved risk discrimination beyond the RCRI. Adding any of these assessments to the RCRI enhanced predictive performance, with FRAIL showing the greatest incremental benefit. These findings underscore the value of multidimensional health status evaluation for preoperative cardiac and cerebrovascular risk stratification, with frailty assessment warranting particular attention. TRIAL REGISTRY: ClinicalTrials.gov, NCT04911530.