Comprehensive geriatric assessment to predict 30-day postoperative morbidity in elderly patients undergoing curative surgery for oral squamous cell carcinoma: A prospective observational study.

Abstract

230 Background: Chronological age alone is an inadequate predictor of surgical outcomes in elderly patients with oral squamous cell carcinoma (OSCC). Comprehensive geriatric assessment (CGA) evaluates multidimensional vulnerabilities and may improve risk stratification. We prospectively evaluated the role of CGA in predicting 30-day postoperative morbidity in elderly patients undergoing curative OSCC surgery. Methods: This prospective observational study included patients ≥70 years undergoing curative OSCC surgery (September 2021–September 2023). Preoperative CGA assessed comorbidities, frailty phenotype, cognition (MMSE), depression (PHQ-9), nutritional status (BMI), ADL/IADL, and falls. Patients with ≥2 impaired domains were classified as “high risk.” Postoperative complications within 30 days were graded using Clavien-Dindo classification. Major morbidity was defined as grade III–V complications. Associations were analyzed using logistic regression. Results: Seventy-four patients were included (mean age 72.5 years; 62% male). Major postoperative morbidity occurred in 17 patients (23%). Thirty-day mortality was 4% (n=3). High-risk CGA status was significantly associated with major morbidity (p=0.02). On multivariate analysis, high-risk CGA status independently predicted major postoperative morbidity (OR 6.02; 95% CI 1.09–33.03; p=0.039). Chronological age was not associated with postoperative complications. Among individual domains, depressive symptoms (PHQ-9) were significantly associated with major morbidity on univariate analysis (OR 4.39; p=0.047). Surgical factors including higher T stage, blood loss >200 ml, and flap reconstruction were also associated with increased morbidity. Conclusions: CGA-based risk stratification independently predicts 30-day major postoperative morbidity in elderly OSCC patients, whereas chronological age does not. Integration of CGA into preoperative evaluation may improve surgical decision-making and perioperative planning in geriatric oncology. Key outcomes and predictors. Variable Major Morbidity (%) p value High-risk CGA 35 0.02 Low-risk CGA 12.5 - Blood loss >200 ml 34 0.04 Flap reconstruction 29 0.03 Age >72 years NS 0.53