New assessment for advanced age: Italian study protocol on the assessment of surgical risk in the over-75-year age-group

Abstract

The role of age in the risk stratification of patients candidate for non-cardiac surgery is still today an unresolved issue. European guidelines, in contrast to American guidelines, do not attribute to age an independent role in increasing the risk, and the indices for assessment of perioperative cardiovascular risk are based on studies that were carried out on middle-aged subgroups of the population without specific attention to the elderly patient. While the indices of geriatric assessment have still not yet gained a standardized role in the risk stratification of patients candidate to non-cardiac surgery, their need is becoming increasingly urgent considering the epidemiological impact of elderly patients with multi-comorbidities who more and more in the future will undergo such interventions. The European guidelines themselves identify an "evidence gap" concerning frailty which requires a deeper evaluation. The aim of the multicenter observational study VALUTA-75 is to verify if the indices of risk stratification routinely used by the cardiologist integrated with those of physical and cognitive performance of specific geriatric pertinence can improve the ability to predict perioperative cardiovascular and non cardiovascular events, with the scope of improving the therapeutic process.

Protocol for evaluation of perioperative risk in patients aged over 75 years: Aged Patient Perioperative Longitudinal Evaluation–Multidisciplinary Trial (APPLE-MDT study)

“…CGA ensures that clinical and functional problems are identified, quantified, and managed appropriately by involving a multidisciplinary team [ 31 ]. There is literature demonstrates CGA can predict a higher risk of adverse outcomes independent of established surgical risk assessment tools [ 23 ].…”

“…However, preoperative evaluation of geriatric patients has not been standardized based on large-scale clinical evidence validated. Therefore, Perioperative management for aged patients still suffers from empirical, subjective in most institutions [ 31 ].…”