Utility of Geriatric Focused Preoperative Assessment in Predicting Postoperative Complications and Outcomes
Background: With Japan’s rapidly aging population, the number of older adults undergoing surgery continues to rise. The American Society of Anesthesiologists Physical Status (ASA-PS) classification, widely used for preoperative evaluation, does not fully capture the heterogeneity and complexity of this population. Several studies have suggested that ASA-PS is not strongly correlated with postoperative complications or long-term outcomes in older adults. In contrast, Comprehensive Geriatric Assessment (CGA) has gained attention as a tool to better evaluate this population, particularly as preoperative physical function decline is associated with poor outcomes. We developed a novel Geriatric Perioperative Risk Assessment (GPRA) tool that combines CGA elements with physical function measures and examined its association with postoperative complications and outcomes. Methods: We retrospectively analyzed 101 consecutive patients aged 70 years or older who underwent elective surgery at our hospital between April 2022 and September 2024 (59 for gastrointestinal diseases, 42 for cardiovascular diseases). The assessment included the key CGA components of the Mini-Mental State Examination and the 15-item Geriatric Depression Scale – Short Form, along with physical function measured by the Five-Times Sit-to-Stand Test. Outcomes included the length of hospital stay, the incidence of postoperative delirium (POD) and other complications, discharge disposition (to home or transfer to another facility), and one-year postoperative mortality. Associations between outcomes and our GPRA system were compared with those of ASA-PS. Results: The mean age of participants was 78.4 ± 5.8 years; 56% were male, and the mean BMI was 22.0 ± 3.5 kg/㎡ . POD occurred in 9 cases. Complications classified as Clavien–Dindo grade Ⅱ or higher occurred in 47% of patients. Among the 101 patients, 84 were discharged to their home and 17 were transferred to another facility. Five patients died within one year of their surgeries. The GPRA tool was significantly associated with POD (p < 0.01) and discharge outcome (p < 0.05). In contrast, ASA-PS was associated with prolonged hospitalization (p < 0.05) and non-delirium complications (p < 0.05). Conclusion: Geriatric Perioperative Risk Assessment incorporating cognitive, psychological, and physical function measures may help predict postoperative delirium and discharge outcomes in older adults. Integrating CGA components into routine preoperative evaluations may support the development of preventive strategies and improve perioperative recovery in older patients.
