• Pasquale Abete, Antonio Cherubini, Mauro Di Bari, Carlo Vigorito, Giorgio Viviani, Niccolò Marchionni, Daniele D'Ambrosio, Alessandro Golino, Rocco Serra, Elena Zampi, Ilaria Bracali, AnnaMaria Mello, Alessandra Vitelli, Giuseppe Rengo, Francesco Cacciatore, and Franco Rengo.
• Dipartimento di Scienze Mediche Traslazionali, Università di Napoli "Federico II", Via S. Pansini, n°5, 80136 Napoli, Italy. Electronic address: p.abete@unina.it.
• Am. J. Surg. 2016 Jan 1; 211 (1): 76-83.e2.

BackgroundThe evaluation of surgical risk is crucial in elderly patients. At present, there is little evidence of the usefulness of comprehensive geriatric assessment (CGA) as a part of the overall assessment of surgical elderly patients.MethodsWe verified whether CGA associated with established surgical risk assessment tools is able to improve the prediction of postoperative morbidity and mortality in 377 elderly patients undergoing elective surgery.ResultsOverall mortality and morbidity were 2.4% and 19.9%, respectively. Multivariate analysis showed that impaired cognitive function (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.15 to 4.22; P < .02) and higher Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (OR, 1.11; 95% CI, 1.00 to 1.23; P < .04) are predictive of mortality. Higher comorbidity is predictive of morbidity (OR, 2.12; 95% CI, 1.06 to 4.22; P < .03) and higher American Society of Anesthesiologists (OR, 2.18; 95% CI, 1.31 to 3.63; P < .001) and National Confidential Enquiry into Patient Outcome of Death score (OR, 2.03; 95% CI, 1.03 to 4.00; P < .04).ConclusionsIn elective surgical elderly patients, the morbidity and mortality are low. The use of CGA improves the identification of elderly patients at higher risk of adverse events, independent of the surgical prognostic indices.Copyright © 2016 Elsevier Inc. All rights reserved.

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