Risk factors prediction of 6-month mortality after noncardiac surgery of older patients in China: a multicentre retrospective cohort study

Abstract

Background: Identifying the risk factors associated with perioperative mortality is crucial, particularly in older patients. Predicting 6-month mortality risk in older patients based on large data sets can assist patients and surgeons in perioperative clinical decision-making. This study aimed to develop a risk prediction model of mortality within 6 months after non-cardiac surgery using the clinical data from 11,894 older patients in China. Materials and Methods: A multicentre, retrospective cohort study was conducted in 20 tertiary hospitals. We retrospectively included 11,894 patients (aged ≥ 65 years) who underwent non-cardiac surgery between April 2020 and April 2022. The least absolute shrinkage and selection operator model based on linear regression was used to analyse and select risk factors, and various machine learning methods were used to build predictive models of 6-month mortality. Results: We predicted 12 preoperative risk factors associated with 6-month mortality in older patients after non-cardiac surgery. Including laboratory-associated risk factors such as mononuclear cell ratio and total blood cholesterol level, etc. Also including medical history associated risk factors such as stroke, history of chronic diseases, etc. By random forest model, we constructed a predictive model with a satisfactory accuracy (area under the receiver operating characteristic curve=0.97). Conclusion: We identified 12 preoperative risk factors associated with 6-month mortality in non-cardiac surgery older patients. These preoperative risk factors may provide evidence for a comprehensive preoperative anaesthesia assessment as well as necessary information for clinical decision-making by anaesthesiologists.