New risk factors of postoperative complications in elective gastrointestinal surgery of elderly patients: a prospective cohort study

Abstract

Background Gastrointestinal 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. Methods This 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. Results Clavien–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. Conclusions Male 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.

The Barthel Index for Predicting Postoperative Complications in Elderly Patients Undergoing Abdominal Surgery: A Prospective Single-center Study

“…In this cohort, the proportion of patients of male sex, with a low serum albumin concentration, and with a prolonged operative time, which are traditionally considered predictors of postoperative complications, was significantly higher in the group with complications of CDc grade ≥II (22,23). Various risk factors and predictors of postoperative complications in gastrointestinal surgical diseases have been reported (24,25).…”

Impact of atherosclerosis on the postoperative complications of colorectal surgery in older patients with colorectal cancer

“…Generally, risk factors for postoperative complications of colorectal surgery include high ASA score, male sex, poor nutritional status, emergency operations, renal failure, diabetes, anemia, and chronic obstructive pulmonary disease [ 24 ]. We previously reported atherosclerosis, male sex, and low skeletal muscle mass as risk factors for postoperative complications in older patients who underwent any type of elective gastrointestinal surgery [ 25 ]. The result of the present study showed that atherosclerosis was a risk factor for postoperative complications in older patients with CRC.…”

Evaluation of respiratory exchange ratio (RER) for predicting postoperative outcomes in elderly patients undergoing oncological resection for gastrointestinal malignancies – A prospective cohort study

“…A recent study found the incidence of complications after gastrointestinal surgery in the elderly age group to be 14.8%. [ 10 ] Considering this incidence rate, the area under the receiver operating characteristic (ROC) curve (AUC) of 0.7, an alpha error of 0.05, a beta error of 0.1, and a null hypothesis value of 0.5, the calculated sample size was 46 patients in each of the two groups, with and without postoperative complications. Including a 10% possible dropout or missing value, the final sample size was calculated to be 100.…”