Why the study?
Geriatric patients are increasingly presenting for surgery globally, but the comparative ability of preoperative scoring systems to predict perioperative outcomes in this population needed evaluation.
Does the Revised Lee Cardiac Risk index better predict perioperative adverse events compared to ASA Physical Status Grades and Generic Scores in geriatric surgical patients?
Does the Revised Lee Cardiac Risk index better predict perioperative adverse events compared to ASA Physical Status Grades and Generic Scores in geriatric surgical patients?
The revised Lee Cardiac Risk Index demonstrated superior predictive ability for immediate perioperative adverse events in geriatric surgical patients compared to ASA and Generic scores.
Lee index may improve geriatric perioperative risk stratification; extends prior scores but hypothesis-generating and should not yet change practice.
Introduction Geriatric patients are increasingly presenting for surgery globally. This study aimed to compare three preoperative scoring systems in their ability to predict perioperative outcomes in geriatric patients who underwent surgical intervention at a tertiary care teaching hospital. Methods A retrospective chart review was done to include geriatric patients (65 years and above) undergoing various surgical procedures. American Society of Anesthesiologists (ASA) Physical Status Grades, Revised Lee Cardiac Risk index, and Generic Scores were assigned to all patients. Demographic data and clinical data including preoperative clinical parameters, the procedure, type and duration of anesthesia, surgical specialty, blood loss, intraoperative and postoperative events, length of stay, postoperative events and survival were recorded. The three scores were compared regarding their ability to predict perioperative adverse events. Results Fifty-four patients were included in the study. The ages ranged from 65 to 87 years (Mean 73.5, 5.8 SD). Females were the majority of patients (64.8%). Patients belonged to general surgery, urology, and thoracic surgery. About 7.4% of the patients developed postoperative events requiring ICU admission. Within the geriatric range, age was not a significant factor impacting perioperative adverse events. Duration of surgery, anesthesia, and hospital length of stay were significantly higher in patients who had perioperative adverse events. With respect to discriminant ability for predicting perioperative adverse events, the area under the Receiver Operating Curve for Lee Cardiac Index was 0.85, 0.67 for the Generic Score, and 0.62 for ASA Physical Status Grades. Conclusion With the limitation of a small sample size, within the patients studied, the revised Lee Cardiac Risk Index was able to predict immediate perioperative adverse events better when compared to the ASA Physical Status Grades and a Generic Score in geriatric patients.
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Lacaille et al. (2025) studied this question.
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