"Gerontosurgery": Evaluation of Multidimensional Assessment Scales for Elderly Patients Undergoing Major Abdominal Surgery. What Is the Best Prediction Model?

Abstract

Background/aim: The aging population poses unique challenges in oncogeriatric surgery, particularly regarding risk stratification and postoperative outcome prediction. The impact of frailty on surgical decision-making reports should be noted. Geriatric assessment scales are recommended for preoperative objective evaluations to optimize surgical outcomes, but their accuracy remains unclear. This study evaluates the effectiveness of five multidimensional geriatric assessment scales - Charlson Comorbidity Index (CCI), APACHE II, Cumulative Illness Rating Scale (CIRS), Identification of Seniors at Risk (ISAR), and G8 - in predicting postoperative complications in elderly patients undergoing major oncological surgery.

Patients and methods: A retrospective observational study was conducted on 69 patients aged ≥75 years who underwent major abdominal surgery for neoplastic conditions between December 2018 and July 2020. Preoperative assessments using the five scoring systems were performed, and postoperative complications were classified according to the Clavien-Dindo system. The study compared the predictive validity of each scale through correlation analysis with postoperative outcomes.

Results: The study found weak correlations between predictive scores and postoperative complications. The G8 scale showed the strongest association with Clavien-Dindo scores (ρ=0.267, p=0.027), while other scales exhibited limited predictive value. Despite the widespread use of these scales in clinical practice, none of them accurately predicted postoperative morbidity in this cohort of patients.

Conclusion: This study highlights the limitations of existing geriatric assessment scales in predicting postoperative complications for elderly patients undergoing major oncological surgery. Among the evaluated tools, only the G8 score showed an association with complications. However, the results suggest a need for more tailored risk stratification models that incorporate comorbidities, frailty, nutritional status, and physiological reserves. Further research with larger sample sizes is necessary to validate these findings and improve preoperative decision-making in geriatric oncologic surgery.

Keywords: Geriatric surgery; frailty; geriatric oncology; post-operative complication; prediction model.