Beyond chronological age: geriatric assessment-based risk stratification for curative surgery in elderly oral...

Chronological age alone is a poor guide to surgical fitness in elderly patients with oral squamous cell carcinoma (OSCC). We prospectively evaluated whether comprehensive geriatric assessment (CGA) performed in a dedicated geriatric oncology clinic predicts 30-day postoperative morbidity in patients ≥70 years undergoing curative surgery for OSCC.

Patients ≥70 years planned for curative-intent OSCC surgery underwent multidisciplinary CGA across eight domains (comorbidity, body mass index, frailty phenotype, cognition, mood, activities of daily living/instrumental activities of daily living, and falls) before surgery. Patients with deficits in ≥2 domains were classified as "high risk." Postoperative morbidity within 30 days was graded using the Clavien-Dindo classification (grade 0-2, no/minor; grade 3-5, major). Univariate and multivariate logistic regression identified independent predictors of major morbidity.

Seventy-four patients (mean age 72.5 ± 2.5 years; 62.2% male) were analysed. Thirty-four patients (46%) were classified as high risk. Major postoperative morbidity occurred in 17 patients (23%), including three deaths (4.1%). On multivariate analysis, high-risk CGA status independently predicted major morbidity (odds ratio [OR] 6.03, 95% confidence interval [CI] 1.10-33.04, p = 0.039), while chronological age did not (OR 0.70, 95% CI 0.16-3.08, p = 0.64). No individual CGA domain remained an independent predictor when analysed alone.

Preoperative CGA-defined high-risk status, rather than chronological age, independently predicts major postoperative morbidity after curative OSCC surgery in elderly patients. A multidomain geriatric assessment, rather than any single domain, should inform perioperative risk stratification and prehabilitation in this population.