Older patients are vulnerable to developing new or worsening disability after surgery. Despite this, patient or surgical characteristics predisposing to postoperative disability are poorly defined. The aim of the study was to develop and validate a model, subsequently transformed to point-score form, to predict 6-month death or disability in older patients after surgery.
The authors built a prospective, single-center registry to develop and validate the prediction model. The registry included patients 70 yr of age or older undergoing elective and nonelective, cardiac and noncardiac surgery between May 25, 2017, and February 11, 2021, and combined clinical data from the electronic medical record, hospital administrative data (International Classification of Diseases, Tenth Revision, Australian Modification codes) and World Health Organization (Geneva, Switzerland) Disability Assessment Schedule data collected directly from the patients. Death or disability was defined as being dead or having a World Health Organization Disability Assessment Schedule score 16% or greater. Included patients were randomly divided into model development (70%) and internal validation (30%) cohorts. Once constructed, the logistic regression and point-score models were assessed using the internal validation cohort and an external validation cohort comprising data from a separate randomized trial.
Of 2,176 patients who completed the World Health Organization Disability Assessment Schedule immediately before surgery, 927 (43%) patients were disabled, and 413 (19%) had significant disability. By 6 months after surgery, 1,640 patients (75%) had data available for the primary outcome analysis. Of these patients, 195 (12%) patients had died, and 691 (42%) were dead or disabled. The developed point-score model included the preoperative World Health Organization Disability Assessment Schedule score, patient age, dementia, and chronic kidney disease. The point score model retained good discrimination in the internal (area under the curve, 0.74; 95% CI, 0.69 to 0.79) and external (area under the curve, 0.77; 95% CI, 0.74 to 0.80) validation data sets.
The authors developed and validated a point score model to predict death or disability in older patients after surgery.
- Older patients are vulnerable to developing new or worsening disability after cardiac or noncardiac surgery
- There are limited data establishing which specific patient or procedure characteristics predict disability at 6 months after surgery
- In a prospective single-center analysis, among 2,176 patients 70 yr of age or older undergoing surgery with preoperative World Health Organization Disability Assessment Schedule data, 1,640 (75%) had 6-month postoperative disability assessment data available
- Six months after surgery, 12% (195 of 1,640) of patients had died, 23% (372) had significant disability, and 42% (691) died or had disability
- A point-score model including the preoperative World Health Organization Disability Assessment Schedule score, patient age, dementia, and chronic kidney disease demonstrated good discrimination in the internal and external validation datasets
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