News: New research shows frailty and probable dementia as increased risk factors for mortality after major surgery

The one-year mortality rate after major surgery was 13.4% for Medicare beneficiaries older than 65, a new research article published by JAMA Surgery shows. Looking at surgeries from 2011 to 2017, the study found that older adults who were not frail had a 6% one-year mortality rate and a 27.8% rate for older adults who were frail. The mortality rate for older adults without dementia was 11.6%, and 32.7% for older adults with probable dementia. This corroborates with earlier research that has found the five-year risk of major surgery for older adults in the United States is 13.8%, HealthLeaders reported.

The study examined 1,193 major surgeries for 992 community-living older adults. The definition of major surgery was any procedure performed in an operating room with general anesthesia. Other key data points from the study include:

• The one-year mortality rate was highest for patients over the age of 90
• The one-year mortality rate for elective surgeries was 7.4%, and the mortality rate for nonelective (unplanned) surgeries was 22.3%
• Older adults who had elective surgery tended to have a more favorable risk profile than older adults who had nonelective surgery, including younger age, higher educational attainment, and lower incidence of frailty as well as possible or probable dementia
• The median time to death was 96 days for all major surgeries, 169 days for elective surgeries, and 62 days for nonelective surgeries

“Our findings suggest substantial differences in 1-year mortality after major surgery across distinct subgroups of older persons and highlight the potential prognostic value of geriatric conditions such as frailty and dementia,” the study’s co-authors wrote. “With improved preoperative optimization and recognition as well as enhanced perioperative management strategies, it is possible that mortality after major surgery could be reduced among older persons, especially those in high-risk subgroups.”

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To read the full JAMA Surgery study, click here.