Background

The global population is aging rapidly, resulting in an increasing number of elderly patients undergoing surgical procedures. Although advances in surgical and anesthetic techniques have improved outcomes, postoperative mortality remains significantly higher among elderly individuals due to age-related physiological decline, comorbidities, frailty, and perioperative complications.

Objective

To identify predictors of postoperative mortality among elderly surgical patients and evaluate the impact of demographic, clinical, operative, and postoperative variables on mortality outcomes.

Methods

A prospective multicenter cohort study was conducted among 2,000 patients aged 65 years and older undergoing major surgical procedures. Demographic data, comorbidities, laboratory findings, frailty assessments, operative variables, and postoperative complications were analyzed. Multivariate logistic regression identified independent predictors of 30-day postoperative mortality.

Results

The overall 30-day postoperative mortality rate was 8.9%. Independent predictors included advanced age (>80 years), frailty, emergency surgery, American Society of Anesthesiologists (ASA) class IV–V, chronic kidney disease, cardiovascular disease, hypoalbuminemia, prolonged operative time, postoperative sepsis, and intensive care unit admission. Frailty demonstrated the strongest association with mortality (OR=5.2, p<0.001).

Conclusion

Postoperative mortality in elderly patients is influenced by multiple interrelated factors. Comprehensive preoperative assessment, frailty screening, optimization of comorbidities, and enhanced perioperative care may significantly reduce mortality risk and improve surgical outcomes.