An Overview of Risk Stratification in the Elderly Orthopaedic Population

Abstract

Orthopaedic surgeries are occurring at an increasing frequency in the elderly patient. The goal of this review was to provide exposure to risk stratification scores to help identify high-risk elderly orthopaedic patients. New guidelines have been developed to assess the risk of cardiopulmonary and other perioperative complications. Older scoring systems, such as the American Society of Anesthesiologists (ASA) score and revised cardiac index, are still of importance as they have strong correlation with risks of cardiac and other complications. Other scoring systems, such as the Estimation of Physiologic Ability and Surgical Stress (E-PASS) score and Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) score, have recently been shown to stratify high-risk elderly patients undergoing hip fracture surgery and other orthopaedic surgeries. The elderly orthopaedic patient has higher risks of perioperative complications than the younger patient. Scoring systems have been developed to help identify those patients at higher risk. Familiarity with these scoring systems will help the practitioner to appropriately select patients for surgery and guide patient counseling on risks on complications and protocols to optimize preoperative care.