Key result
Multiple preoperative screening tools, including the ASA-PS, frailty indices, and comprehensive geriatric assessments, were associated with poor short-term postoperative outcomes in older elective surgical patients, but heterogeneity prevented identifying a single superior tool.
Why the study?
Older surgical patients face higher postoperative mortality and morbidity, making timely identification of high-risk patients crucial for optimization and resource allocation.
Do preoperative screening tools predict short-term postoperative outcomes in older patients undergoing elective surgery?
Systematic Review
Do preoperative screening tools predict short-term postoperative outcomes in older patients undergoing elective surgery?
Multiple preoperative screening tools, particularly frailty and functional assessments, are associated with short-term postoperative mortality and morbidity in older elective surgical patients, though no single tool is definitively superior.
No single preoperative tool identified as superior for older elective surgery patients; leaves open need for head-to-head validation studies before routine adoption.
BACKGROUND: Older surgical patients have a higher risk of postoperative mortality and morbidity compared to younger patients. Timely identification of high-risk patients facilitates comprehensive preoperative evaluation, optimization, and resource allocation to help reduce this risk. This review aims to identify a preoperative screening tool for older patients undergoing elective surgery predictive of poor short-term postoperative outcomes. METHODS: A scoping review was conducted. An Ovid MEDLINE search was used to identify systematic reviews or meta-analyses comprising older elective patients in at least two different surgical settings. International guidelines were reviewed for recommendations regarding preoperative tools in this population. RESULTS: Over 50 screening tools were identified. The majority showed a positive association with short-term postoperative mortality and morbidity in older patients. The most commonly described tools were the American Society of Anesthesiologists Physical Status (ASA-PS), frailty tools and domain-specific tools administered as part of comprehensive geriatric assessment (CGA). Due to heterogeneity in outcome measures and statistical methodology the predictive capacity between tools could not be compared. International guidelines described a comprehensive preoperative approach incorporating domain-specific tools rather than recommending a screening tool. CONCLUSION: Multiple tools were associated with poor short-term postoperative outcomes in older elective surgical patients. No single superior tool could be identified. Frailty, cognitive and/or functional tools were most frequently utilized.
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Aitken et al. (2020) conducted a systematic review in Older patients undergoing elective surgery. Preoperative screening tools (e.g., ASA-PS, frailty tools, CGA) vs. Lower risk scores or non-frail status was evaluated on Short-term postoperative mortality and morbidity. Multiple preoperative screening tools, including the ASA-PS, frailty indices, and comprehensive geriatric assessments, were associated with poor short-term postoperative outcomes in older elective surgical patients, but heterogeneity prevented identifying a single superior tool.
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