This document discusses three prospective studies that aim to evaluate risk factors for adverse outcomes in elderly patients undergoing non-cardiac surgery. The first study compares the predictive accuracy of the AUB-HAS2 index, RCRI index, and frailty scale on postoperative mortality and morbidity. The second study examines the relationship between frailty status and postoperative complications in patients receiving general or regional anesthesia. The third study determines the prognostic validity of nutritional status, body composition, and muscle strength on postoperative complications, mortality, and length of stay. All three studies involve assessing elderly surgical patients preoperatively and tracking outcomes within 30 days.

1. Preop cardiovascular risk assessment
an essential step
initial evaluation and management
patients undergoing noncardiac surgery.
The Revised Cardiac Risk Index (RCRI)
most commonly used
relative simplicity
The AUB-HAS2 index stratifies patients
3 risk groups:
low risk (score 0–1)
intermediate risk (score 2–3)
high risk (score >3)
• Prediction of operative risk using available
risk scores is less accurate in elderly patients
referred for non-cardiac surgery.
• Elderly patients often present with a heavy
burden of comorbidity, disability, and
perceived frailty.
• Frailty scale provides incremental
prognostic value above surgical risk scores
for predicting mortality or major morbidity.
INTRODUCTION (Study 1)

4. • The objective of the study:
• Analyze the performance of the AUB-HAS2 index and RCRI index in addition to the frailty score to
identify elderly patients at high risk of mortality and morbidity.
• Perioperative assessment of a broad spectrum of surgical subpopulations under general anaesthesia
and regional anaesthesia to provide incremental prognostic value to above surgical risk scores for
predicting mortality or major morbidity.
• Primary outcome measure: Death, Myocardial infarction, Stroke at 30 days after surgery.
Myocardial infarction
• acute myocardial infarction (at least 1 of the following factors: ST elevation >1 mm in 2 or more
contiguous leads; new left bundle branch; or new Q waves in 2 of more contiguous leads),
• new elevation in troponin >3-fold the upper level of the reference range in the setting of suspected
myocardial ischemia
Stroke
• new occurrence of a motor, sensory, or cognitive dysfunction that persists for >24 hours

5. Study Population: Age 60 years and above, both male and female, undergoing non-cardiac surgeries
AUB-HAS 2 scoring
(Questionnaire)
RCRI scoring
(Questionnaire)
With and without
Frailty scoring
(Questionnaire)
Surgery under GA Surgery under RA
AUB-HAS 2 scoring
(Questionnaire)
Methods
Follow up after 30
days
Comparison of scoring indexes with respect to morbidity and mortality in two
anaesthesia groups

9. • Elderly people form a growing proportion of the surgical population and often have complex
health problems.
• Frailty is a common geriatric syndrome associated with poor health outcomes.
• Frailty is a term that has been widely used, although there is no standard universally
accepted definition. It has been described as a phenotype that identifies people with
reduced physiological reserve in multiple organ systems, and who as a result have increased
vulnerability to physiological stressors.
• Assessing a patient’s frailty during the routine preoperative assessment may help stratify
perioperative risks for that patient.
INTRODUCTION (Study 2)

10. • Objective: This study will examine the relationship between frailty status and the
incidence of in-hospital postoperative complications in elderly surgical patients across
several surgical disciplines under GA or RA.
• Primary outcome measures: The incidence and type of postoperative complications will
be assessed until discharge from the hospital in GA or RA groups.
• Design: Prospective observational study.

11. Study Population: Age 60 years and above, both male and female, undergoing non-cardiac surgeries
Surgery under GA Surgery under RA
Methods
General Frailty assessment in both groups
Pre- Frail Frail
Non- Frail
Assessment of postoperative complications (PPC, Delirium) via POMS in elderly patients in GA and RA groups and non-
frail, pre-frail, and frail subgroups on the basis of frailty scores.
optimization of patient counselling, process planning, and risk reduction protocols based on the application of risk
stratification

12. Post-operative Morbidity Survey:

13. • Patients undergoing major surgeries are highly susceptible to malnutrition.
• Lean body tissue loss, phase angle attenuation, and edema development could serve as
potential surrogates to risk stratification.
• Nutritional status and body composition assessment could aim toward prognosis refinement.
• Body composition assessment could be part of a patient-oriented multimodal approach in
surgery under GA or RA.
INTRODUCTION (Study 3)

14. • Objective: This study will aim to determine the prognostic validity of nutritional status,
body composition, phase angle, and muscle strength assessment on the basis of
morbidity and mortality in the population undergoing surgery under GA or RA.
• Primary outcome measures: The incidence and type of postoperative complications,
mortality, and length of hospital stay will be assessed until discharge from the hospital in
GA or RA groups.
• Design: Prospective, cohort study.

15. Study Population: Age 60 years and above, both male and female, undergoing non-cardiac surgeries
Surgery under GA Surgery under RA
Methods
Demographics
Anthropometric,
Biochemical
parameters
BMI Body composition
assessment
(Bioelectrical Impedance
Preoperative Postoperative
On 3rd and
7th day
Comparison and evaluation of postoperative complications, hospital stay, and in-hospital mortality will be registered for
every participant in GA and RA groups