Background: Frailty is increasingly being recognized as a risk factor for adverse outcomes in older surgical patients undergoing surgery. We investigated the association between frailty and intraoperative complications using multiple frailty assessment tools in older patients undergoing elective intermediate- to high-risk non-cardiac surgery. Methods: This retrospective cohort study included 637 older patients scheduled for elective non-cardiac surgery. Frailty was assessed using the Clinical Frailty Scale (CFS), FRAIL scale, and modified Frailty Index-11 (mFI-11). The predictive ability of frailty tools was analyzed and compared using the area under the receiver operating characteristic curve (AUC). Results: Frailty was significantly associated with higher intraoperative complication rates (FRAIL scale: p = 0.01; mFI-11: p = 0.046). Patients considered frail using the mFI-11 were more likely to have unplanned intensive care unit admissions (p < 0.001). Those classified as frail by the FRAIL scale and mFI-11 had significantly higher rates of vasopressor/inotrope use (p = 0.001 and p = 0.005, respectively) and mechanical ventilation (p = 0.033 and p = 0.007, respectively). In the univariate analysis, frailty measured using the FRAIL scale was significantly associated with intraoperative complications (odds ratio [OR], 2.41; 95% confidence interval [CI]: 1.33–4.38; p = 0.004); this association was not significant in the multivariate analysis (adjusted OR, 1.69; 95% CI: 0.83–3.43; p = 0.148; AUC = 0.550). Atrial fibrillation, hemoglobin levels, anesthesia type, and surgical subspecialty were stronger predictors of intraoperative complications. Conclusions: Frailty assessments demonstrate the limited predictive ability for intraoperative complications. Specific comorbidities, surgical techniques, and anesthesia types play more critical roles. Comprehensive preoperative evaluations integrating frailty with broader risk stratification methods are necessary to enhance patient outcomes and ensure safety.

To compare sensitivity, specificity, receiver operating characteristic (ROC), and area under the curve (AUC) values using the modified Frailty Index 11 (mFI-11), EuroSCORE II, and combined mFI-11 and EuroSCORE II to predict in-hospital mortality and composite morbidities. Retrospective cohort study SETTING: Songklanagarind Hospital, a tertiary care center in southern Thailand. Elderly patients age ≥60 years who underwent elective open-heart surgical procedures on a pump between January 2017 and December 2022 were included. ROC curves were constructed to evaluate the discriminatory power of EuroSCORE II and mFI-11 for predicting in-hospital mortality and postoperative complications. The actual in-hospital mortality was 2.5% for all patients. The discriminative accuracy of mFI-11, EuroSCORE II, and combined mFI-11 with EuroSCORE II for predicting in-hospital mortality was good, with respective AUC values of 0.733 (95% confidence interval [CI], 0.6157-0.8499), 0.793 (95% CI, 0.6826-0.9026), and 0.78 (95% CI, 0.6686-0.893). The AUC of mFI-11 for predicting postoperative cardiac, respiratory, neurologic, and renal complications was 0.558 (95% CI, 0.5101-0.6063), 0.606 (95% CI, 0.5542-0.6581), 0.543 (95% CI, 0.4533-0.6337), and 0.652 (95% CI, 0.5859-0.7179), respectively, and that of EuroSCORE II was 0.553 (95% CI, 0.5038-0.6013), 0.631 (95% CI, 0.578-0.6836), 0.619 (95% CI, 0.5306-0.7076), and 0.702 (95% CI, 0.6378-0.7657), respectively. The mFI-11 and EuroSCORE II demonstrated good discrimination in ROC analysis, with EuroSCORE II showing superior predictive accuracy for in-hospital mortality in elderly elective cardiac surgery patients. However, neither score independently predicted mortality in multiple logistic regression, nor did combining them enhance predictive power significantly. Furthermore, both scores were less effective in predicting postoperative complications.

Background: Oxidative stress and systemic inflammation during cardiac surgery can lead to postoperative complications. Although vitamin C and thiamine (vitamin B1) have individually demonstrated protective effects, their combined effects remain underexplored. This study aimed to evaluate the efficacy of combined vitamin C and B1 therapy versus that of vitamin C alone in reducing inflammatory and cardiac biomarkers and improving postoperative outcomes in patients undergoing cardiac surgery. Methods: In this prospective, double-blind, randomized controlled trial, 64 patients scheduled for elective cardiac surgery at a tertiary care center were randomized to receive either 1000 mg vitamin C or a combination of 1000 mg vitamin C and 100 mg vitamin B1 at four perioperative time points. Primary outcomes included changes in inflammatory biomarkers [C-reactive protein, interleukin-6 (IL-6), and white blood cells], and cardiac biomarkers [creatine kinase-MB, Troponin-I, and lactate dehydrogenase]. Secondary outcomes included hemodynamic parameters and left ventricular function. Results: Compared with vitamin C alone, combined vitamin B1 and vitamin C significantly reduced postoperative cardiac biomarker levels. IL-6 levels were significantly lower immediately in the combined group; however, this effect was not sustained at 24 h post-surgery. Up to 24 h after surgery, no significant differences in hemodynamic stability or left ventricular ejection were observed between the groups. Notably, the combined therapy group demonstrated a lower incidence of postoperative arrhythmias and shorter dobutamine duration within 24 postoperatively. Conclusions: Combined vitamin C and B1 therapy significantly reduced markers of myocardial injury and early inflammatory responses (IL-6) in patients undergoing cardiac surgery, suggesting its potential as a protective agent.

Introduction: Frailty and malnutrition are closely linked to adverse surgical outcomes. However, their combined influence on post-non-cardiac surgery complications in older patients remains unclear. We aimed to evaluate the predictive value of frailty, malnutrition, and their combined effect on postoperative complications in older patients undergoing intermediate- to high-risk non-cardiac surgery.Methods: This study was a retrospective analysis of data from a prospectively collected cohort that included 637 patients aged ≥60 years. We assessed frailty using the Clinical Frailty Scale (CFS) and nutritional status using the Prognostic Nutritional Index (PNI). The primary outcome was the occurrence of postoperative complications (Clavien-Dindo classification ≥2). We used logistic regression and receiver-operating characteristic (ROC) analyses to determine the predictive accuracy of CFS, PNI, and CFS + PNI.Results: We identified frailty (CFS ≥ 5) in 38.5% of patients, with 29.8% being malnourished (PNI < 45). Multivariate analysis revealed that frailty independently predicted postoperative complications (odds ratio [OR]: 2.09, 95% confidence interval [CI]: 1.09–4.00; p = 0.026). Severe malnutrition (PNI < 40) exhibited a strong association with complications in univariate analysis (OR: 5.88, 95%CI: 3.13–11.08; p < 0.001) but not in multivariate analysis. The combined CFS + PNI model showed enhanced discriminative ability (area under the curve [AUC]: 0.694, 95%CI: 0.647–0.740) compared with CFS (AUC: 0.619, 95%CI: 0.575–0.662) or PNI (AUC: 0.665, 95%CI: 0.618–0.712) alone.Conclusion: Frailty is a strong independent predictor of postoperative complications in older patients undergoing non-cardiac surgery. Although severe malnutrition correlates with increased risk, its effect may be partially mediated by frailty. The integration of frailty and nutritional assessments enhances postoperative complication prediction, underscoring comprehensive geriatric evaluation value in preoperative risk stratification.

Background: To highlight the risk assessment tool associated with postoperative cardiopulmonary complications of Clavien–Dindo (CD) ≥ II in elderly patients who underwent lung cancer surgery. Methods: In patients ≥ 60 years admitted during 2020–2023 and having undergone lung cancer surgery, postoperative cardiopulmonary complications were examined using the CD classification as groups (CD grade I versus ≥ II), and the risk factors were analyzed using logistic regression and receiver operating characteristic (ROC) curves. Results: Of the 239 elderly patients, 29.3% had postoperative complications (CD ≥ II). Subgroup analysis revealed that patients aged ≥70 years had a higher rate of postoperative complications compared to those aged 60–69 years, however, this relationship was not statistically significant in the multivariable model (OR: 2.03, 95% CI: 0.95–4.36, p = 0.068). The CD grade ≥ II group had longer surgical time (p = 0.002), greater postoperative pulmonary complications (p < 0.001), and longer length of hospital stay (p < 0.001); CD grade ≥ II was more likely in patients with older age (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.02–1.15, p = 0.011), COPD (OR: 4.41, 95% CI: 1.55–13.44, p = 0.005) and smoking history (OR: 2.85, 95% CI: 1.12–7.24, p = 0.028), having undergone pneumonectomy (OR: 14.89, 95% CI: 1.71–334.9, p = 0.045), and who converted to open thoracotomy (OR: 16.33, 95% CI: 2.13–169.71, p = 0.007). The area under the ROC curve was 0.81. Conclusions: Older age (≥70 years) is associated with higher rates of postoperative complications (CD classification ≥ II) but is not an independent predictor when adjusting for other factors. Comorbidities such as COPD and surgical factors, including pneumonectomy and conversion to thoracotomy, are significant contributors. These findings emphasize the need for comprehensive, multifactorial risk assessments to guide perioperative management and improve outcomes in elderly lung cancer patients.

Objective: To observe the frequency and causes of first-case tardiness and its consequences.Material and Methods: Six months of data from scheduled surgical patients from 18 operating rooms (OR), under 13 surgical subspecialties, between September 2014 and February 2015, in a tertiary-care university hospital, were collected. We aimed to identify: (1) the rate and tardy time of first-case tardiness, (2) the time of overutilization caused by first-case tardiness, and (3) the cancellation rate due to first-case tardiness.Results: From a total of 3,965 elective surgical cases, 1,343 qualified as first cases and were included for analysis. Six hundred forty-four cases (48%) started more than 10 minutes later than the scheduled time. The mean (S.D.) tardy time was 25.1 (16.9) minutes. The total tardy time due to first-case tardiness was 16,146 minutes (33.6 8-hour OR days). The late physical presence of surgeons was responsible for most tardy first cases (80.6%). Of a designated OR, in which the first case was delayed, the 419 final cases in the schedule of ORs continued beyond working hours and 65 cases were cancelled. Moreover, of the 52,028 minutes (108.4 8-hour OR days) of OR overutilization, 9,465 minutes (19.7 8-hour OR days) were due to first-case tardiness.Conclusion: First-case tardiness creates substantial futile time and a trickle-down effect on the subsequent cases of a designated OR-either case cancelation or operating room overutilization.