Nationwide Real-World Modeling of Surgical Outcomes in Elderly Patients: Incorporating Geriatric-Specific Risk...

As the aging population grows, it is crucial to evaluate the quality of surgical care considering geriatric-specific factors and outcomes. The aim of this study was to develop and validate prediction models for mortality and morbidity in patients aged 65 and older by using a large-scale, nationwide, real-world dataset to enable robust and generalizable modeling and to evaluate the contribution of geriatric-specific risk factors to the model.

Data from the National Clinical Database in 2021, incorporating 22 geriatric-specific variables, was used to develop prediction models for 30-day mortality and major complications using 70% of the dataset (development cohort), with validation on the remaining 30% (validation cohort).

A total of 64 868 cases from gastroenterological surgeries were analyzed. In this geriatric cohort, the 30-day mortality rate was 1.8%, and the major complication rate was 11.3%. The prediction models demonstrated strong discrimination and calibration (HL = 0.198 and c-statistics = 0.84 for mortality, HL = 0.0003 and c-statistics = 0.68 for morbidity). The mortality prediction model identified three significant geriatric-specific factors as independent predictors: surrogate consent (odds ratio [OR] 1.91; 95% confidence interval [CI] 1.55-2.35), depression (OR 1.68; 95% CI 1.02-2.75), and hospitalization from outside the home (OR 1.24; 95% CI 1.01-1.54), along with age (75-79 years vs. 65-69 years, OR 1.62; 95% CI 1.20-2.19).

Incorporating geriatric-specific factors along with age identified clinically relevant predictors of mortality and morbidity, reinforcing the importance of geriatric assessment in elderly surgical patients.