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Usefulness of pre- and intraoperative risk scores in nonagenarian surgical patients

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Abstract

Purpose

Preoperative assessment at extreme ages would identify patients at a high risk of developing postoperative complications. The objective of this study was to compare the usefulness of different risk scales in a series of nonagenarian surgical patients.

Methods

A total of 244 surgical nonagenarians, 148 women (60.7%), median age 91 years (IQR: 90–93), were analysed. The following scales were evaluated: preoperative status (ASA-PS, Charlson Comorbidity Index, Lee Index, Reiss Index, and surgical mortality probability model—S-MPM); intraoperative status (Surgical Apgar Score and SASA score), and, as output variables, surgical outcomes (morbidity measured by the Comprehensive Complication Index—CCI, and death). Univariate analysis and receiver operating characteristic curves (ROC) were performed. Area under ROC curves (AUROC) were evaluated to define the best predictors of poor outcomes.

Results

Operative mortality was 27.0%, and 73.4% presented some type of postoperative complication. Operative mortality was associated with the ASA-PS score (p < 0.001), Reiss Index (p < 0.001), Lee Index (p = 0.010), S-MPM (p < 0.001), Surgical Apgar Score (p < 0.001), SASA score (p < 0.001), and emergency surgery (p < 0.001). Postoperative complications were related to the ASA-PS score (p = 0.001), Reiss Index (p < 0.001), Lee Index (p < 0.001), S-MPM (p < 0.001), Surgical Apgar Score (p < 0.001) and SASA score (p < 0.001). The best predictors of operative mortality and complications were the SASA and Surgical Apgar Score (AUROCs > 0.88).

Conclusion

As in the general population, the Surgical Apgar Score and SASA score are the best predictors of operative mortality and morbidity in nonagenarian patients. These risk scales should be considered in the perioperative management of these patients.

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Authors and Affiliations

  1. Department of Anesthesiology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco La Ballena s/n., 35012, Las Palmas de Gran Canaria, Las Palmas, Spain

    Roberto Fariña-Castro

  2. Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco La Ballena s/n., 35012, Las Palmas de Gran Canaria, Las Palmas, Spain

    Cristina Roque-Castellano, Manuel Artiles-Armas & Joaquín Marchena-Gómez

  3. Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco La Ballena s/n., 35012, Las Palmas de Gran Canaria, Las Palmas, Spain

    Alicia Conde-Martel

Authors
  1. Roberto Fariña-Castro
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  2. Cristina Roque-Castellano
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  3. Manuel Artiles-Armas
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  4. Alicia Conde-Martel
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  5. Joaquín Marchena-Gómez
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Correspondence to Joaquín Marchena-Gómez.

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Fariña-Castro, R., Roque-Castellano, C., Artiles-Armas, M. et al. Usefulness of pre- and intraoperative risk scores in nonagenarian surgical patients. J Anesth 34, 650–657 (2020). https://doi.org/10.1007/s00540-020-02799-3

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  • DOI: https://doi.org/10.1007/s00540-020-02799-3

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