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When Is Old NOT Gold? Identifying Global Age Risk Surgical Thresholds to Improve Outcomes
Komal Abdul Rahim1, Kinzah Razzak Ghazi2, Kantesh Kumar3
1Centre of Excellence for Trauma and Emergencies & Dean's Office, Aga Khan University, Karachi, Pakistan.
Insights
Identifying the optimal age threshold for surgical risk stratification is crucial. Patients aged 52.595 and above in Pakistan face increased postoperative mortality and complications, necessitating targeted interventions.
Area of Science:
- Surgical outcomes research
- Geriatric surgery
- Health services research
Background:
- Patient age significantly impacts healthcare outcomes, but optimal risk thresholds remain unclear.
- Limited evidence exists on specific age cutoffs that increase adverse surgical outcomes, particularly in low- and middle-income countries.
- Preoperative risk stratification is essential for optimizing surgical outcomes and guiding clinical decisions.
Purpose of the Study:
- To identify the optimal age threshold for classifying surgical patients as high-risk in Pakistan.
- To utilize the modified frailty index for preoperative risk stratification.
- To inform clinical decision-making and improve surgical outcomes.
Main Methods:
- Analysis of American College of Surgeons National Surgical Quality Improvement Program data (2019-2022).
- Identification of high-risk patients using the modified frailty index (score ≥ 2).
- Application of receiver-operator curve (ROC) analysis to determine the optimal age threshold and Cox proportional regression for hazard ratios.
Main Results:
- A total of 10,060 patients were analyzed, with an optimal age threshold for high-risk identified at 52.595 years (AUC 0.72).
- Patients aged 52.595 years and above exhibited twice the postoperative mortality (2.95% vs. 1.11%) and higher complication rates (27.01% vs. 19.28%).
- Case acuity and postoperative cardiac complications were significant predictors of mortality in both risk groups.
Conclusions:
- Age is a significant factor associated with adverse outcomes in the surgical population.
- Establishing an age threshold for high-risk surgical patients is critical for implementing targeted interventions in low- and middle-income countries.
- This study provides a crucial age cutoff for risk stratification to improve surgical care in Pakistan.
Introduction:
Patient age has been shown to influence health-care outcomes; however, there is limited evidence on the optimal cutoff where age increases the risk of adverse outcomes. This study aims to identify the age at which patients undergoing surgery in Pakistan can be classified as high-risk using the modified frailty index which can help in preoperative risk stratification, optimizing surgical outcomes, and guiding clinical decision-making.
Methods:
American College of Surgeons National Surgical Quality Improvement Program data of adult patients undergoing major elective surgeries from 2019 to 2022 were used. High-risk patients were identified using the modified frailty index tool with a score of 2 and above. A receiver-operator curve (ROC) was used to determine the optimal age threshold for high-risk patients. Cox proportional regression identified hazard ratios for low and high-risk patients.
Results:
A total of 10,060 surgical patients were identified. The optimal age threshold was 52.595 years (sensitivity: 79%, specificity: 72%, area under the curve 0.72). An age of 52.595 years and above was the high-risk group. The postoperative mortality was twice in the high-risk group compared to the low-risk group (2.95% & 1.11%; P value<0.001). All postoperative complications were higher in the high-risk compared to the low-risk group (27.01% & 19.28%). Case acuity and postoperative cardiac complication were significantly associated with mortality in low- and high-risk group.
Conclusions:
Our findings indicated that age was associated with adverse outcomes in surgical population. Determining this age threshold in low- and middle-income countries is crucial for improving surgical outcomes via targeted interventions.
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