Can we predict postoperative complications in octogenarians undergoing lung resection?

BACKGROUND: This study aimed to determine the parameters that should be taken into consideration to predict the development of postoperative complications in patients aged 80 years and over (octogenarians) who underwent lung resection. METHODS: The data of 49 octogenarian patients who underwent lung resection between January 2016 and June 2025 were retrospectively analyzed. Patient demographics, operative parameters, and predictive indices and scores for postoperative complications (Charlson Comorbidity Index (CCI), Simplified Comorbidity Index (SCI), American Society of Anesthesiologists (ASA), Glasgow Prognostic Score (GPS), The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) and Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM)) were calculated. Postoperative complications were recorded according to the Clavien-Dindo classification. RESULTS: The mean age of the patients, 79.6% of whom were male, was 81.98 ± 2.07 years. Statistically significantly fewer complications were observed in those who underwent sublobar resection compared to lobar resection (38.9% vs. 76.9%, p = 0.019). No correlation was found between CCI, SCI, ASA, and GPS scores and the development of complications (p = 0.170, p = 0.246, p = 0.774, p = 0.158, respectively), while ARISCAT and POSSUM scores were found to be predictive of complication development (p < 0.001, p < 0.001). In the multivariate analysis, while the extent of resection lost its status as an independent risk factor (p = 0.222), the classified ARISCAT score and the POSSUM score grouped according to the cut-off value determined by ROC analysis remained independent factors in predicting the development of complications. Patients in the high-risk group according to the ARISCAT score (OR = 16.482, 95% CI = 1.376-197.339, p = 0.027) and those with a POSSUM score above 31.100 (OR = 36.308, 95% CI = 3.889-338.952, p = 0.002) had a significantly higher incidence of postoperative complications. CONCLUSIONS: In this single-centre study, higher ARISCAT and POSSUM scores were associated with the development of postoperative complications in octogenarians. Given the limited sample size, the wide confidence intervals, and the predominance of minor (Clavien-Dindo grade I-II) complications, these scores should be regarded as promising adjuncts for risk stratification that require validation in larger, prospective, multicentre studies before being applied to patient selection.