Preoperative geriatric assessment and postoperative outcomes in older adults at risk for frailty-related complications following major surgery: a retrospective comparative cohort study

Frailty increases surgical risk for older adults, yet structured preoperative geriatric assessment (PGA) remains underused. We evaluated whether structured, hospital-based PGA improves outcomes and reduces healthcare utilization in older patients undergoing major elective surgery. Adults ≥ 65 insured by Maccabi Healthcare Services (Israel) who underwent specified elective orthopedic or abdominal surgeries at Assuta Medical Center between 2019 and 2023. This retrospective comparative cohort study linked de-identified clinical and administrative datasets. The intervention group (N = 191) received PGA using an Adapted Surgical Frailty Score, while 3,068 controls underwent similar procedures without PGA. Controls were categorized by level of prior geriatric input and grouped by age, sex, surgery type, and SES to enhance baseline comparability. Outcomes included one-year mortality, hospitalizations, ED visits, home care use, long-term care, and costs. Chi-square and t-tests were used to compare groups. PGA was associated with lower one-year mortality compared with control groups, reaching statistical significance for selected comparisons, including controls with prior or minimal geriatric intervention (2.6% vs. up to 12% in some controls; p < 0.01), but not for those with no documented geriatric intervention. PGA was also associated with lower rates of emergency department visits, hospitalizations, and home care utilization in selected control comparisons. Average monthly healthcare costs were lower in the PGA group during both immediate and extended postoperative periods. No significant differences were found in registry-based morbidity indicators, though trends favored the PGA group. Control groups with minimal or no geriatric input resembled the intervention group more than those with prior community-based consultations. Structured, hospital-based PGA may be associated with improved clinical outcomes and lower health system utilization, supporting consideration of broader adoption within preoperative workflows. Future research should explore the optimal timing, structure, and continuity of geriatric input to maximize potential benefit. This study was not registered in a clinical trial registry. • Structured, hospital-based preoperative geriatric assessment (PGA) was associated with lower one-year mortality and reduced healthcare utilization among older adults undergoing major elective surgery and at risk for frailty-related complications. • Patients receiving PGA had fewer ED visits, hospitalizations, home care use, and institutionalization compared to contemporaneous control groups. • Findings highlight the added value of integrating PGA within surgical pathways rather than relying solely on community-based or fragmented assessments.