Review of risk assessment tools to predict morbidity and mortality in elderly surgical patients

Informed surgical consent requires accurate estimation of risks and benefits. Multiple risk assessment tools are available; however, most are not widely used or are specific to certain interventions. Assessing surgical risk is especially challenging in elderly patients because of their range of comorbidities, level of frailty, or severity of illness and a number of available surgical interventions. We searched MEDLINE from January 2014 to July 2017 for studies that used risk assessment tools in studies on elderly surgical patients. We then sought the original articles describing each assessment tool and subsequent validation studies. We identified risk assessment tools that can improve surgical risk assessment in elderly surgical patients. The majority of the identified tools are not commonly used for pre-operative risk assessment. NSQIP-PMP, mFI and SURPAS are promising tools. Age is commonly used to predict risk, but frailty may be a more appropriate measure. •The majority of risk assessment tools developed are not commonly used.•NSQIP-PMP, modified Frailty Index and SURPAS are promising assessment tools.•The use of frailty assessment during risk assessment may better predict outcomes.•Frailty should be incorporated into future risk assessment tools for the elderly.