Multidimensional Prognostic Index in Surgery: A Clinical Perspective

Comprehensive Geriatric Assessment (CGA) is a multidimensional and multidisciplinary process to identify the medical, social, and functional needs of older people and to develop a care plan to meet those needs. Several studies and meta-analyses demonstrated the efficacy of CGA in improving healthcare outcomes in different settings, including surgical setting, and various clinical conditions. The Multidimensional Prognostic Index (MPI) is a validated prognostic tool, based on information collected during a standard CGA, which demonstrated excellent accuracy, feasibility, and calibration in predicting several negative healthcare outcomes such as hospitalization, institutionalization, length of hospital stay, and death, in older patients across different settings. The MPI has compelling evidence to support its utility in the surgical setting, addressing and exploring multiple domains simultaneously, i.e., functions of daily living activities, cognition, nutrition, mobility, co-habitation, co-morbidity, and polypharmacy, in order to guarantee a multidimensional approach to the older subject beyond a chronological age only and/or one-dimensional organicistic view of risk assessment. Indeed, the MPI has been successfully employed in ortho-geriatrics, cardio-surgery, oncology, gastrointestinal, and liver diseases, demonstrating its usefulness during the perioperative period: (i) preoperatively for risk assessment and clinical decision-making; (ii) perioperatively for treatment program tailoring; and (iii) postoperatively for the prevention of complications and long-term management of patients. To provide appropriate guidance in CGA implementation in multiple scenarios, the first Italian Guideline on the CGA for Older Persons was recently released. In conclusion, a CGA-based easy-to-use, reliable, comprehensive tool like the MPI can assist physicians in better managing surgical older patients.