Review of risk assessment tools to predict morbidity and mortality in elderly surgical patients

Gilgamesh Eamer; Mohamed J H Al-Amoodi; Jayna Holroyd-Leduc; Darryl B Rolfson; Lindsey M Warkentin; Rachel G Khadaroo

doi:10.1016/j.amjsurg.2018.04.006

Review of risk assessment tools to predict morbidity and mortality in elderly surgical patients

Am J Surg. 2018 Sep;216(3):585-594. doi: 10.1016/j.amjsurg.2018.04.006. Epub 2018 Apr 18.

Authors

Gilgamesh Eamer¹, Mohamed J H Al-Amoodi¹, Jayna Holroyd-Leduc², Darryl B Rolfson³, Lindsey M Warkentin¹, Rachel G Khadaroo⁴

Affiliations

¹ Department of Surgery, University of Alberta, Edmonton, Canada.
² Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary, Calgary, Canada.
³ Department of Medicine, University of Alberta, Edmonton, Canada.
⁴ Department of Surgery, University of Alberta, Edmonton, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Canada. Electronic address: khadaroo@ualberta.ca.

PMID: 29776643
DOI: 10.1016/j.amjsurg.2018.04.006

Abstract

Background: Informed surgical consent requires accurate estimation of risks and benefits. Multiple risk assessment tools are available; however, most are not widely used or are specific to certain interventions. Assessing surgical risk is especially challenging in elderly patients because of their range of comorbidities, level of frailty, or severity of illness and a number of available surgical interventions.

Data sources: We searched MEDLINE from January 2014 to July 2017 for studies that used risk assessment tools in studies on elderly surgical patients. We then sought the original articles describing each assessment tool and subsequent validation studies.

Conclusions: We identified risk assessment tools that can improve surgical risk assessment in elderly surgical patients. The majority of the identified tools are not commonly used for pre-operative risk assessment. NSQIP-PMP, mFI and SURPAS are promising tools. Age is commonly used to predict risk, but frailty may be a more appropriate measure.

Keywords: Elderly; Emergency; Frail; Geriatric; Morbidity; Mortality; Predictors; Review; Risk assessment; Scores; Tool.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Age Factors
Aged
Frailty / epidemiology*
Geriatric Assessment / methods*
Global Health
Humans
Morbidity / trends
Postoperative Complications / epidemiology*
Risk Assessment*
Risk Factors
Survival Rate / trends