title: The validity of the VA surgical risk tool in predicting postoperative mortality among octogenarians.
abstract: BACKGROUND
  To examine the validity of Veterans Affair-VA risk assessment tool in predicting the perioperative and overall mortality among octogenarians.
  
  
  METHODS
  This is a single-institution retrospective observational study, in which the clinical information of 1,618 octogenarians were extracted from the VA Surgical Quality Improvement Program database. VA risk assessment tool and ASA classification were used to predict the probability of postoperative mortality and morbidity. Multiple risk groups were compared for mortality using multiple logistic regressions.
  
  
  RESULTS
  There were 570 survivors and 1,048 nonsurvivors. VA risk tool strongly predicted perioperative 30-day mortality in receiver operator characteristic curve analysis (area under the curve: .82 ± .02). The power of this tool, while acceptable, was less in predicting overall mortality (area under the curve: .68 ± .01). Age, dialysis, a history of congestive heart failure, functional status, transfusion, and weight loss were also associated with increased rate of death within 30 days.
  
  
  CONCLUSIONS
  VA risk tool predicted both perioperative and overall mortality. Relatively strong power of this tool in predicting overall mortality may be unique to this age group because of their advanced age.
authors.affiliation: Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA.
authors.forename: Ata H
authors.initials: AH
authors.lastname: Afshar
authors.affiliation: Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA.
authors.forename: Navyugjit
authors.initials: N
authors.lastname: Virk
authors.affiliation: Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA; VAWestern NY Healthcare System, Anesthesiology Services, Buffalo, NY.
authors.forename: Jahan
authors.initials: J
authors.lastname: Porhomayon
authors.affiliation: Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA.
authors.forename: Leili
authors.initials: L
authors.lastname: Pourafkari
authors.affiliation: VA Western NY Healthcare System, Surgical Services, Buffalo, NY.
authors.forename: Hasan H
authors.initials: HH
authors.lastname: Dosluoglu
authors.affiliation: Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA; VAWestern NY Healthcare System, Anesthesiology Services, Buffalo, NY. Electronic address: nnader@buffalo.edu.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000401:mortality*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: Mortality; Outcome; Risk assessment; Surgery; Veterans