[Evaluation of surgical risk in elderly patients: a review of 207 cases]

Thorough evaluation of surgical risk represents the sine qua non for a correct therapeutic choice particularly in the elderly who are frequently affected by multiple pathologies. The aim of this study was to evaluate the prognostic value of two of the most common classification systems for predicting surgical risk (ASA and Reiss scores) and of other laboratory parameters. A consecutive series of 207 patients aged 70 or above were analysed retrospectively, considering age, ASA and Reiss scores, elective or emergency surgery, operative time, leucocytes, haemoglobin, creatinine, and albumin levels. Morbidity and mortality rates were compared in relation to these parameters. Emergency surgery was associated with significantly higher morbidity (P = 0.006 chi-square) and mortality (P = 0.001 chi-square) than elective surgery. No differences in morbidity were noted in association with the ASA classification (P = 0.07 chi-square), though there was a significant difference (P = 0.001 chi-square) in mortality. Significant differences in both morbidity (P = 0.04 chi-square) and mortality (P = 0.001 chi-square) were found to be associated with the Reiss classification. Multivariate analysis showed that ASA score (P = 0.006), Reiss score (P = 0.004), operative time (P = 0.005), and haemoglobin level (P = 0.01) were independent prognostic factors. The results of the study confirm the prognostic value of multiparametric classifications such as the ASA and Reiss score in elderly patients, even if the addition of other prognostic factors may be expected to improve the sensitivity.