Key result
Surgical risk stratification (moderate-risk P=0.045; high-risk P=0.001), but not comorbidities, was associated with major postoperative morbidity or 30-day mortality in patients aged ≥95 years.
Why the study?
Is the Charlson Comorbidity Index or ACC/AHA Surgical Risk Stratification associated with poor surgical outcomes in patients aged 95 years or older?
Observational (n=187)
Is the Charlson Comorbidity Index or ACC/AHA Surgical Risk Stratification associated with poor surgical outcomes in patients aged 95 years or older?
p-value: p=0.045 for moderate-risk, 0.001 for high-risk
In extremely elderly surgical patients (≥95 years), surgical risk stratification rather than baseline comorbidities predicts 30-day mortality and major morbidity.
May inform preoperative risk discussions in patients ≥95 years; leaves open whether comorbidity indices add prognostic value beyond procedure risk.
The Charlson Comorbidity Index (CCI) has not been assessed for elderly (95 years of age or older) surgical patients. We examined the association between the CCI and life-threatening complications and 30-day mortality rate. Medical records of patients 95 years old or older from 2004 through 2008 were reviewed for major postoperative morbidity or death. Logistic regression analyses of age, sex, the CCI, American College of Cardiology/American Heart Association Surgical Risk Stratification, and surgical urgency were performed to identify associations with poor surgical outcome. One hundred eighty-seven patients were identified (mean [standard deviation] age, 96.6 [1.9] years; median [interquartile range] CCI, 4 [2 to 6]). Ninety patients (48.1%) underwent moderate-risk and 20 (10.7%) underwent high-risk surgical procedures. Twenty patients (10.7%) died within 30 postoperative days and 20 others had major morbidity. Only moderate-risk (P = 0.045) and high-risk surgical procedures (P = 0.001) were associated with poor outcome. Patients of advanced age have high rates of morbidity and death after surgical procedures. These events are associated with surgical risk stratification and are independent of patient comorbidities. Risks, benefits, and alternatives must be considered carefully and discussed with patients and their families before deciding to proceed with high-risk surgery.
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Larson et al. (2014) conducted an observational in Advanced-age surgical patients (n=187). Surgical risk severity and Charlson Comorbidity Index was evaluated on Major postoperative morbidity or death within 30 postoperative days (p=0.045 for moderate-risk, 0.001 for high-risk). Surgical risk stratification (moderate-risk P=0.045; high-risk P=0.001), but not comorbidities, was associated with major postoperative morbidity or 30-day mortality in patients aged ≥95 years.
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