The global elderly population is increasing rapidly, resulting in a growing number of surgical procedures performed among older adults. Elderly patients are particularly vulnerable to postoperative complications and mortality due to age-related physiological changes, multiple comorbidities, frailty, and reduced physiological reserve.

Objective

This study aimed to identify clinical, surgical, and perioperative predictors associated with postoperative mortality in elderly patients undergoing major surgical procedures.

Methods

A multicenter retrospective cohort study was conducted among 850 patients aged 65 years and older who underwent elective or emergency surgery. Demographic data, comorbidities, laboratory findings, surgical characteristics, perioperative complications, and mortality outcomes were analyzed using multivariate logistic regression.

Results

The overall postoperative mortality rate was 9.8%. Independent predictors of mortality included advanced age (>80 years), frailty, emergency surgery, cardiovascular disease, chronic kidney disease, hypoalbuminemia, prolonged operative duration, and postoperative sepsis. Frailty demonstrated the strongest association with mortality (OR=3.82, p<0.001).

Conclusion

Postoperative mortality among elderly patients is influenced by multiple modifiable and non-modifiable risk factors. Early risk assessment, comprehensive geriatric evaluation, optimization of comorbidities, and multidisciplinary perioperative care can significantly improve outcomes.