The Holy Grail of Geriatric Surgery is a simple, reliable test to assess perioperative risk. Have the authors found it?It seems intuitive to most people, even most physicians, that advanced age increases operative risk; but is chronologic age itself really the culprit? We all know octogenarians who play vigorous tennis and others who cannot walk to the mailbox. Most of the possible tests to clarify risk in this highly variable group are surrogates of the standardized cardiopulmonary exercise test (CPET) that the authors studied. These surrogates, utilized because CPET is unavailable in some locales and unappealing in others, all suffer from one or more inadequacies, although some have been correlated with maximal oxygen consumption or surgical risk or even cancer survival: stair climbing, 6-Minute Walk Test, Long-Distance Corridor Walk, gait speed, Shuttle-Walk test, Timed Up-and-Go test, Braden scale, various frailty scales, Surgical Apgar Score, Charlson Comorbidity Index score, American Society of Anesthesiology (ASA) Physical Status Classification, and visceral assessment of an experienced surgeon.
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