title: Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study.
abstract: BACKGROUND
  The evaluation of surgical risk is crucial in elderly patients. At present, there is little evidence of the usefulness of comprehensive geriatric assessment (CGA) as a part of the overall assessment of surgical elderly patients.
  
  
  METHODS
  We verified whether CGA associated with established surgical risk assessment tools is able to improve the prediction of postoperative morbidity and mortality in 377 elderly patients undergoing elective surgery.
  
  
  RESULTS
  Overall mortality and morbidity were 2.4% and 19.9%, respectively. Multivariate analysis showed that impaired cognitive function (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.15 to 4.22; P < .02) and higher Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (OR, 1.11; 95% CI, 1.00 to 1.23; P < .04) are predictive of mortality. Higher comorbidity is predictive of morbidity (OR, 2.12; 95% CI, 1.06 to 4.22; P < .03) and higher American Society of Anesthesiologists (OR, 2.18; 95% CI, 1.31 to 3.63; P < .001) and National Confidential Enquiry into Patient Outcome of Death score (OR, 2.03; 95% CI, 1.03 to 4.00; P < .04).
  
  
  CONCLUSIONS
  In elective surgical elderly patients, the morbidity and mortality are low. The use of CGA improves the identification of elderly patients at higher risk of adverse events, independent of the surgical prognostic indices.
authors.affiliation: Dipartimento di Scienze Mediche Traslazionali, Università di Napoli "Federico II", Via S. Pansini, n°5, 80136 Napoli, Italy. Electronic address: p.abete@unina.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Abete
authors.affiliation: Geriatria ed Accettazione Geriatrica d'urgenza, IRCCS-INRCA, Ancona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cherubini
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Bari
authors.affiliation: Dipartimento di Scienze Mediche Traslazionali, Università di Napoli "Federico II", Via S. Pansini, n°5, 80136 Napoli, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Vigorito
authors.affiliation: Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Viviani
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.affiliation: Dipartimento di Scienze Mediche Traslazionali, Università di Napoli "Federico II", Via S. Pansini, n°5, 80136 Napoli, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: D'Ambrosio
authors.affiliation: Dipartimento di Scienze Mediche Traslazionali, Università di Napoli "Federico II", Via S. Pansini, n°5, 80136 Napoli, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Golino
authors.affiliation: Sezione di Gerontologia e Geriatria, Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Serra
authors.affiliation: Sezione di Gerontologia e Geriatria, Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Zampi
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Bracali
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: AnnaMaria
authors.initials: A
authors.lastname: Mello
authors.affiliation: Dipartimento di Scienze Mediche Traslazionali, Università di Napoli "Federico II", Via S. Pansini, n°5, 80136 Napoli, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Vitelli
authors.affiliation: Fonadazione Salvatore Maugeri IRCCS Istituto Scientifico di Telese, Benevento, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rengo
authors.affiliation: Fonadazione Salvatore Maugeri IRCCS Istituto Scientifico di Telese, Benevento, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cacciatore
authors.affiliation: Fonadazione Salvatore Maugeri IRCCS Istituto Scientifico di Telese, Benevento, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Rengo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Comprehensive geriatric assessment; Elderly patient; Morbidity; Mortality; Surgical risk