Which preoperative screening tool should be applied to older patients undergoing elective surgery to predict short-term postoperative outcomes? Lessons from systematic reviews, meta-analyses and guidelines

Rachel Aitken, Nur Shirin Harun, Andrea Britta Maier*

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review

Abstract

Background: Older surgical patients have a higher risk of postoperative mortality and morbidity compared to younger patients. Timely identification of high-risk patients facilitates comprehensive preoperative evaluation, optimization, and resource allocation to help reduce this risk. This review aims to identify a preoperative screening tool for older patients undergoing elective surgery predictive of poor short-term postoperative outcomes. Methods: A scoping review was conducted. An Ovid MEDLINE search was used to identify systematic reviews or meta-analyses comprising older elective patients in at least two different surgical settings. International guidelines were reviewed for recommendations regarding preoperative tools in this population. Results: Over 50 screening tools were identified. The majority showed a positive association with short-term postoperative mortality and morbidity in older patients. The most commonly described tools were the American Society of Anesthesiologists Physical Status (ASA-PS), frailty tools and domain-specific tools administered as part of comprehensive geriatric assessment (CGA). Due to heterogeneity in outcome measures and statistical methodology the predictive capacity between tools could not be compared. International guidelines described a comprehensive preoperative approach incorporating domain-specific tools rather than recommending a screening tool. Conclusion: Multiple tools were associated with poor short-term postoperative outcomes in older elective surgical patients. No single superior tool could be identified. Frailty, cognitive and/or functional tools were most frequently utilized.

Original languageEnglish
Pages (from-to)37-48
Number of pages12
JournalInternal and Emergency Medicine
Volume16
Issue number1
Early online date1 Jul 2020
DOIs
Publication statusPublished - Jan 2021

Funding

This research is based on an unrestricted grant provided by the University of Melbourne received by Prof. Andrea B. Maier.

FundersFunder number
Melbourne Dental School
University of Melbourne
Melbourne School of Psychological Sciences

    Keywords

    • Aged
    • Frailty
    • Geriatric assessment
    • Preoperative care
    • Screening tool
    • Surgery

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