Mortality Predictors in Patients 80+ After Major Abdominal Surgery: Role of Frailty and Physiological Reserve

Mortality Predictors After Major Abdominal Surgery in Patients Aged 80 and Over: The Role of Frailty and Physiological Reserve

The aim of this study is to identify independent risk factors for 30-day mortality in patients aged 80 and over who have undergone major abdominal surgery. While traditional risk scoring systems often focus on chronic disease burden, they may not fully capture the biological decline associated with aging. This research specifically focuses on the predictive value of "frailty" and "physiological reserve" in determining surgical outcomes for this "old-old" patient population.

In this retrospective cohort study, data from approximately 200 patients treated between 2022 and 2025 will be analyzed. Frailty will be assessed using the Modified Frailty Index (mFI-5), and physiological reserve will be evaluated through preoperative laboratory markers such as albumin, creatinine, and lymphocyte counts. By determining how these factors influence postoperative mortality, the study aims to improve preoperative patient selection, enhance risk communication with families, and provide a basis for protective strategies like prehabilitation.

Study Overview

• Status: Completed
• Conditions: Postoperative Complications; Frailty; Aged, 80 and Over; Abdomen Cancer
• Intervention / Treatment: Other: Major Abdominal Surgery and Frailty Assessment

Detailed Description

As the global population ages, the "old-old" (aged 80 and over) patient group is increasingly encountered in surgical clinics. Major abdominal surgery in this demographic is categorized as high-risk due to both the severity of surgical trauma and the presence of multiple comorbidities. Traditional risk assessment tools often emphasize chronic disease burden but may fail to reflect the loss of biological resilience inherent in aging. "Frailty" has emerged as a critical parameter in predicting surgical outcomes, representing a state of reduced physiological reserve and increased vulnerability to stressors, independent of chronological age.

This retrospective study is designed to investigate the independent predictors of 30-day mortality in patients aged 80 and older who underwent major abdominal surgery (including gynecologic oncology, surgical oncology, and urologic oncology procedures) at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital.

Methodology and Data Collection:

Patient data from the years 2022, 2023, 2024, and 2025 will be extracted from the hospital's electronic database. The study will include approximately 200 patients who meet the inclusion criteria.

Frailty Assessment: The Modified Frailty Index (mFI-5) will be utilized to evaluate the frailty status of each patient. This index is a validated tool for retrospective studies and includes parameters such as functional status and history of specific comorbidities.

Physiological Reserve: This will be assessed using objective preoperative clinical and laboratory parameters, including serum albumin levels, creatinine, leukocyte/lymphocyte ratios, hemoglobin levels, and the American Society of Anesthesiologists (ASA) physical status score.

Outcome Measure: The primary endpoint is 30-day postoperative mortality. If 30-day follow-up data is not available in the hospital records, patients or their relatives will be contacted via telephone to determine the survival status.

• Study Type: Observational
• Enrollment (Actual): 100

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Yenimahalle
    • Ankara, Yenimahalle, Turkey (Türkiye), 06200
      • Dr. Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital Clinic of Anesthesiology and Rea

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of "old-old" patients (aged 80 years and older) who underwent major abdominal surgery at a tertiary oncology center (Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital) between January 2022 and December 2025. This population includes patients who received surgical interventions in the departments of surgical oncology, gynecologic oncology, and urologic oncology. The sample represents a high-risk geriatric group undergoing complex oncological or major abdominal procedures, where frailty and physiological reserve are critical factors for survival.

Description

Inclusion Criteria:

• Patients aged 80 years and older
• Underwent major abdominal surgery between January 2022 and December 2025
• Availability of at least 30 days of postoperative follow-up data
• Complete medical records available in the hospital information system

Exclusion Criteria:

• Patients under 80 years of age
• Underwent surgical procedures other than major abdominal surgery
• Missing or incomplete follow-up data within the first 30 days postoperatively
• Insufficient data for the assessment of frailty (mFI-5) or physiological reserve parameters (e.g., missing preoperative laboratory values)

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
30-Day Postoperative Mortality	The occurrence of death from any cause within 30 days following the major abdominal surgical procedure. This will be assessed using hospital electronic records and, if necessary, through telephone follow-ups with patients or their relatives.	From the date of surgery up to 30 days postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Modified Frailty Index (mFI-5) Score	Assessment of patients' frailty status using the Modified Frailty Index (mFI-5). The mFI-5 consists of 5 items: history of hypertension, diabetes mellitus, congestive heart failure, chronic obstructive pulmonary disease, and functional status. Each item is assigned 1 point if present. The total score ranges from 0 to 5, where 0 represents "not frail" and 5 represents "severely frail." Higher scores indicate a higher degree of frailty and a worse clinical outcome	Preoperative assessment (retrospective data from 2022-2025)
Preoperative Serum Albumin Level	Evaluation of preoperative serum albumin levels (measured in g/dL) as an indicator of nutritional status and physiological reserve.	Preoperative laboratory values collected retrospectively from 2022-2025.
Preoperative Serum Creatinine Level	Evaluation of preoperative serum creatinine levels (measured in mg/dL) to assess renal function as part of the physiological reserve	Preoperative laboratory values collected retrospectively from 2022-2025.
Preoperative Hemoglobin Level	Evaluation of preoperative hemoglobin levels (measured in g/dL) to assess the oxygen-carrying capacity and physiological reserve.	Preoperative laboratory values collected retrospectively from 2022-2025

Collaborators and Investigators

• Sponsor: Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital

Publications and helpful links

General Publications

• Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010 Jun;210(6):901-8. doi: 10.1016/j.jamcollsurg.2010.01.028. Epub 2010 Apr 28.
• Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56. doi: 10.1093/gerona/56.3.m146.
• Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013 Mar 2;381(9868):752-62. doi: 10.1016/S0140-6736(12)62167-9. Epub 2013 Feb 8.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2026
• Primary Completion (Actual): April 1, 2026
• Study Completion (Actual): April 10, 2026

Study Registration Dates

• First Submitted: February 20, 2026
• First Submitted That Met QC Criteria: February 25, 2026
• First Posted (Actual): February 27, 2026

Study Record Updates

• Last Update Posted (Actual): April 30, 2026
• Last Update Submitted That Met QC Criteria: April 26, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Pathological Conditions, Signs and Symptoms; Frailty; Postoperative Complications
• Other Study ID Numbers: 2026-02/31

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: To protect patient privacy and comply with institutional data protection policies

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No