The validity of the VA surgical risk tool in predicting postoperative mortality among octogenarians

• National Surgical Quality Improvement Program was originally started within the Veteran Health Affair and then adopted by the American College of Surgeons.
• Veterans Affair continued the same system under in a new name VA Surgical Quality Improvement Program.
• This program is equipped to a tool that calculates the individual risk of perioperative mortality and morbidity.
• This study has demonstrated that this risk assessment tool strongly predicts the risk of perioperative death among the octogenarians.
• Although it is not as powerful, this tool acceptably predicts the risk of overall mortality in this population.

BackgroundTo examine the validity of Veterans Affair–VA risk assessment tool in predicting the perioperative and overall mortality among octogenarians.MethodsThis is a single-institution retrospective observational study, in which the clinical information of 1,618 octogenarians were extracted from the VA Surgical Quality Improvement Program database. VA risk assessment tool and ASA classification were used to predict the probability of postoperative mortality and morbidity. Multiple risk groups were compared for mortality using multiple logistic regressions.ResultsThere were 570 survivors and 1,048 nonsurvivors. VA risk tool strongly predicted perioperative 30-day mortality in receiver operator characteristic curve analysis (area under the curve: .82 ± .02). The power of this tool, while acceptable, was less in predicting overall mortality (area under the curve: .68 ± .01). Age, dialysis, a history of congestive heart failure, functional status, transfusion, and weight loss were also associated with increased rate of death within 30 days.ConclusionsVA risk tool predicted both perioperative and overall mortality. Relatively strong power of this tool in predicting overall mortality may be unique to this age group because of their advanced age.