Overview
Emerging evidence highlights the critical role of preoperative functional status in shaping postoperative outcomes for elderly patients. This study investigates how the Short Physical Performance Battery (SPPB), a quick and objective measure of frailty, relates to the risk of 30-day postoperative pulmonary complications (PPCs) after elective major abdominal surgery.
Study Design and Population
In this single-center cohort, 645 patients aged 65 years and older who were scheduled for elective major abdominal surgery under general anesthesia were analyzed between April 2023 and November 2024. The team used the SPPB to assess preoperative functional status the day before surgery. Participants were divided into two groups: a low-SPPB group (<10) and a high-SPPB group (≥10). PPCs were tracked for 30 days postoperatively and defined by criteria including atelectasis, pulmonary infection, and acute respiratory distress syndrome, among others.
Key Findings: SPPB as an Independent Predictor
Among the 645 patients, 205 were classified as low-SPPB and 440 as high-SPPB. The incidence of PPCs was notably higher in the low-SPPB group (32.7%) compared with the high-SPPB group (21.6%), with a statistically significant difference (P = 0.002).
Multivariate logistic regression, adjusted for a range of potential confounders (age, anemia, albumin, BMI, ASA class, comorbidities, site of surgery, and intraoperative factors), demonstrated that a higher preoperative SPPB score independently predicted a reduced risk of PPCs (odds ratio [OR] = 0.63; 95% CI: 0.42–0.94; P = 0.025). In practical terms, this translates to an absolute risk reduction of about 11% for patients with SPPB scores of 10 or higher, yielding a number needed to treat (NNT) of approximately nine to prevent one PPC. These results reinforce the value of functional assessment as part of preoperative planning.
Clinical Implications
The SPPB offers a concise, objective snapshot of frailty and physiological reserve. Its advantages include minimal time, modest training requirements, and applicability in small spaces, making it feasible for routine preoperative clinics. By identifying patients at heightened risk for PPCs, clinicians can tailor perioperative care—implementing targeted respiratory therapies, enhanced mobilization, and individualized optimization strategies before major abdominal procedures.
Subgroup Insights and Robustness
Stratified analyses showed the protective association of a higher SPPB score in several subgroups, including males, those under 80, and patients with anemia. Although some subgroup findings are exploratory, the overall pattern supports the SPPB’s utility across diverse elderly patients facing abdominal surgery.
Comparison with Other Frailty Metrics
Compared with other frailty assessments, the SPPB demonstrated favorable discriminative ability in predicting PPCs. Receiver operating characteristic (ROC) analyses suggested the SPPB has a stronger association with PPC risk than some alternatives, underscoring its value as a practical screening tool in preoperative pathways for older adults.
Limitations and Future Directions
As a single-center observational study, causality cannot be definitively established. About 11% of eligible patients were excluded due to missing SPPB data or non-abdominal procedures, which could introduce selection bias. The SPPB, while robust, can exhibit ceiling effects in highly functional individuals. Future multicenter studies should combine SPPB with additional measures and biomarkers to refine risk stratification and intervention strategies for PPC prevention in elderly patients undergoing major abdominal surgery.
Conclusion
Elevated preoperative SPPB scores are independently associated with a lower risk of 30-day PPCs in elderly patients undergoing elective major abdominal surgery. Incorporating SPPB into preoperative evaluation can help identify at-risk individuals and inform targeted preventive strategies to improve postoperative respiratory outcomes.
