Abstract
BackgroundGastrointestinal surgery in elderly individuals presents unexpected postoperative complications. However, predicting postoperative complications in elderly patients undergoing gastrointestinal surgeries is challenging because of the lack of a reliable preoperative evaluation system. We aimed to prospectively evaluate three new preoperative assessment methods to predict the postoperative complications in elderly patients undergoing elective gastrointestinal surgery. Moreover, we aimed to identify new risk factors of postoperative complications in this patient group.MethodsThis prospective cohort study enrolled 189 patients (age ≥ 65 years) who underwent elective gastrointestinal surgery at Tokyo Medical University Hachioji Medical Center between April 2017 and March 2019. Assessments performed preoperatively included the biological impedance analysis for evaluating the skeletal muscle mass, the SF-8 questionnaire for evaluating the subjective health-related quality of life, and the blood pressure/pulse wave test for assessing arteriosclerosis. The risk factors for Clavien–Dindo Grade ≥ III postoperative complications were assessed using these new evaluation methods.ResultsClavien–Dindo Grade ≥ III postoperative complications were observed in 28 patients (14.8%). Univariate and multivariate analyses identified male sex, low skeletal muscle mass, and cardio-ankle vascular index ≥ 10 (arteriosclerosis) as significant independent risk factors of developing Grade ≥ III complications.ConclusionsMale sex, low skeletal muscle mass, and arteriosclerosis were significant risk factors of postoperative complications in elderly patients undergoing elective gastrointestinal surgery. The obtained knowledge could be useful in identifying high-risk patients who require careful perioperative management.
Highlights
Gastrointestinal surgery in elderly individuals presents unexpected postoperative complications
Unexpected postoperative complications can often occur in elderly patients, unlike in younger patients
This study prospectively evaluated three new preoperative tests to predict the postoperative complications of elective GI surgery in elderly patients
Summary
Gastrointestinal surgery in elderly individuals presents unexpected postoperative complications. We aimed to prospectively evaluate three new preoperative assessment methods to predict the postoperative complications in elderly patients undergoing elective gastrointestinal surgery. In 2014, approximately 25.9% of the Japanese population were older than 65 years [1]. The surgical indication of elective gastrointestinal (GI) surgery for elderly individuals has been determined based on standard preoperative evaluations, such as blood tests, physiological function tests, and performance status. Unexpected postoperative complications can often occur in elderly patients, unlike in younger patients. Predicting postoperative complications in elderly patients undergoing gastrointestinal surgeries is challenging because of the lack of a reliable preoperative evaluation system
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