K. Khan1, Y. Chou1, S. E. Wozniak1, J. Coleman1, V. Ahuja1, M. R. Katlic1 1Sinai Hospital,General Surgery,Baltimore, MD, USA
Introduction: Age has been shown in multiple studies to be a risk factor for postoperative morbidity and mortality; however, some centers have reported excellent results in the geriatric population. This leads to the question that began our research study: Is there a concise preoperative evaluation in the elderly that is simple and reliable to assess perioperative risk? Numerous geriatric and frailty evaluations exist; however these have been shown to be extensive and complicated to perform. Therefore, few of these tests are actually applied in routine practice. We have attempted to construct the most practical preoperative geriatric evaluation, and then evaluate it among our geriatric population.
Methods: At our center for geriatric surgery we provide a comprehensive preoperative assessment on patients aged ≥ 75 years prior to any elective surgery. Issues identified by this preoperative screening lead to further care and assessment.
In contrast to the extensive preoperative geriatric assessment, we selected six simple tests that have each been shown to be predictive of poor outcomes in the elderly: mini-Cog test, gait speed, timed-up-and-go, Charleston Comorbidity Index, activities of daily living, and American Society of Anesthesiologists Physical Classification (ASA).
Results: From October, 2012 to August, 2016 we have prospectively evaluated 1088 patients that have been retrospectively reviewed for implementation into a database consisting of perioperative variables and NSQIP post-surgical outcomes. There were 387 males (36%) and 701 females (64%) that ranged in age from 75-100 years. The 110 patients that underwent minor surgery (ophthalmic surgery, arthroscopy) were excluded. The remaining 978 patients underwent major surgery including orthopedic, surgical oncology, cardiothoracic, general surgery, urologic and vascular surgery (table).
The combination of tests that we selected is currently being evaluated in a validation cohort against Fried’s frailty phenotype, ASA, Charleston Comorbidity Index and the eyeball test.
Conclusion: We believe that this combination assessed in the scoring system that we have developed, will be as accurate as other assessments, while remaining practical and easily remembered by providers.
