Elderly age and the risk of postoperative complications in elective abdominal surgery: results of the multicenter study STOPRISK
TL;DR
Older age (65–75 years) is an independent predictor of postoperative complications and mortality following elective abdominal surgery, increasing the risk of complications 1.7-fold and the risk of death 2.2-fold after confounder adjustment.
Abstract
INTRODUCTION: Older age is recognized as an independent risk factor for adverse perioperative outcomes; however, quantitative data on the impact of early old age (65–75 years) on 30-day postoperative complications in a multicenter Russian cohort are lacking.
Objective
To determine whether older age (65–75 years) is associated with the incidence, pattern, severity, and timing of 30-day postoperative complications and mortality compared with patients aged 18–64 years undergoing elective abdominal surgery.
Materials And Methods
A multicenter prospective cohort study was conducted (secondary analysis of the STOPRISK database, NCT03945968; STROBE). From 2019 to 2024, 12,000 patients from 38 centers across the Russian Federation were enrolled. After exclusions, the analytical sample comprised 10,915 patients: 18–64 years (n = 8,119) and 65–75 years (n = 2,796). The primary outcome was any 30-day postoperative complication (ESA/ESICM). Secondary outcomes were 30-day mortality, complication severity (Clavien-Dindo), and timing of occurrence.
Results
The 30-day complication rate in patients aged 65–75 years was more than twice that in the 18–64-year group (7.15 vs 3.09 %), and 30-day mortality was more than threefold higher (1.18 vs 0.33 %). The greatest relative risk increase was observed for postoperative delirium (RR 7.55), acute myocardial infarction (RR 5.08), arrhythmias (RR 4.26), and acute kidney injury (RR 3.87). The distribution of complication severity according to Clavien-Dindo did not differ between groups, most complications in both groups occurred within the first 5 days. After multivariable adjustment, older age remained an independent predictor of any complications, severe complications, and mortality.
Conclusions
Older age (65–75 years) is an independent predictor of postoperative complications and mortality following elective abdominal surgery, increasing the risk of complications 1.7-fold and the risk of death 2.2-fold after confounder adjustment. The identified profile of high-risk specific complications supports the need for targeted perioperative management protocols in elderly patients.