Estimating Risk of Postsurgical General and Geriatric Complications Using the VESPA Preoperative Tool

Area of Science:

• Geriatric Medicine
• Surgical Risk Assessment
• Health Services Research

Background:

• Increasing numbers of older adults undergo elective surgery.
• Enhanced preoperative evaluation is crucial for preventing postoperative complications in this demographic.
• Geriatric-specific assessment tools are needed to optimize preoperative risk stratification.

Purpose of the Study:

• To evaluate the implementation of a geriatric assessment tool in a preoperative clinic.
• To determine the tool's efficacy in estimating the risk of postoperative complications in older patients.
• To assess the sustainability of the implemented tool over time.

Main Methods:

• Prospective cohort study of patients aged 70+ undergoing elective surgery.
• Utilized the Vulnerable Elders Surgical Pathways and Outcomes Assessment (VESPA) tool, including activities of daily living, fall history, mood, cognition, and gait/balance.
• Collected comorbidity data and work-related relative value units; employed multivariable logistic regression for risk estimation.

Main Results:

• The VESPA tool was successfully implemented in a preoperative clinic setting.
• Difficulties with activities of daily living, anticipated self-care challenges, higher comorbidity scores, male sex, and higher work-related relative value units were associated with increased complication risk.
• The VESPA score demonstrated strong predictive accuracy (AUC, 0.76) for postoperative complications.

Conclusions:

• Preoperative geriatric assessment is feasible within general preoperative clinics.
• The VESPA tool effectively identifies older patients at elevated risk for postoperative complications.
• This approach can improve preoperative risk assessment and potentially mitigate adverse surgical outcomes in the elderly.