Preoperative Risk Scores in Elderly with Gastrointestinal Malignancies: Their Predictive Value for Postoperative Mortality and Morbidity

Abstract

Aim: The incidence of gastrointestinal cancers has shifted to older age groups with global population aging. Elderly patients often present with diminished reserves and comorbidities, necessitating individualized risk assessment. This study aimed to evaluate preoperative risk assessment tools, including the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), American Society of Anesthesiologists (ASA) score, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS), in predicting early postoperative outcomes in elderly patients undergoing curative gastrointestinal cancer surgery. Material and Methods: This retrospective study included patients aged ≥75 years (n=65) and 50–65 years (n=60) who underwent curative surgery between 2019 and 2023. Comorbidities, ASA scores, ECOG-PS, POSSUM scores, postoperative complications, and early mortality were analyzed. Results: Elderly patients had significantly higher comorbidity rates, ASA, ECOG-PS, and POSSUM scores. Although early mortality and ICU stays were more frequent in elderly patients, multivariate analysis did not identify age ≥75 as an independent risk factor. The ASA score was significantly associated with postoperative morbidity (OR: 3.2, 95%CI: 1.5–6.7), whereas POSSUM and ECOG-PS scores were not predictive of early mortality. Conclusion: Age alone is not an independent predictor of postoperative outcomes. Higher ASA scores are strongly associated with morbidity, emphasizing the need for comprehensive preoperative assessments.

Keywords

• preoperative risk scores
• elderly
• gastrointestinal cancer

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