Worse ECOG-PS Is Associated with Increased 30-Day Mortality among Adults Older than 90 Years Undergoing Non-Cardiac Surgery: A Single-Center Retrospective Study

Abstract

A growing number of older patients are undergoing surgeries. However, reliable preoperative predictors of surgical mortality among older patients have not been identified. This study compared predictive factors for 30-day survival in patients older than 90 years after non-cardiac surgery.This retrospective study at Nippon Medical School Hospital investigated the records of patients aged >90 years who underwent non-cardiac surgeries between 2010 and 2020. The data collected included age, gender, American Society of Anesthesiologists physical status (ASA-PS), preoperative Charlson score, preoperative fall risk assessment, Eastern Cooperative Oncology Group performance status (ECOG-PS), modified 5-item frailty index (mFI-5), need for intraoperative transfusion, postoperative complications, and 30-day survival after surgery.A total of 327 cases of elective surgery and 149 cases of emergency surgery were examined. Nonsurvivors (n=20, 4.2%) had significantly worse preoperative ASA-PS (for emergency cases) (nonsurvivors vs. survivors, 2.8 [2-3] vs. 2.3 [1-4], p=0.045), ECOG-PS (3.0 [2-4] vs. 1.0 [0-4], p<0.001), and mFI-5 values (3.0 [1-4] vs. 1.0 [0-3], p<0.001), more emergency cases (75.0% vs. 36.2%, p=0.004), and a greater need for intraoperative transfusion (55.0% vs. 13.4%, p<0.001). Among frailty assessment methods, ECOG-PS was the most strongly associated with 30-day mortality (area under the curve, ECOG-PS: 0.98, p<0.001; mFI-5: 0.86, p<0.001; Charlson score: 0.53, p=0.71; fall risk assessment: 0.55, p=0.44). Kaplan-Maier curves and multivariate logistic regression analysis demonstrated that an ECOG-PS of >3 was significantly associated with 30-day mortality (ECOG-PS: Kaplan-Maier curve, p<0.001, Log-rank test; odds ratio 1.71, 95% confidence interval: 1.35-2.16, p<0.001).An ECOG-PS of >3 was significantly correlated with 30-day mortality after non-cardiac surgery in patients older than 90 years.