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Baldo A, Chatzipanagiotou OP, Woldesenbet S, et al. J Am Coll Surg. November 2025.

Medicare claims (2016鈥�2021) identified 780,337 beneficiaries 鈮�66 years who underwent major operations (coronary artery bypass grafting, pneumonectomy, abdominal aortic aneurysm repair, pancreatectomy, and colectomy). 鈥淕eriatric syndrome鈥� (GS) was defined as any new diagnosis during the index stay of delirium, falls/fracture, pressure ulcer, failure to thrive, dehydration, incontinence, depression, or malnutrition. 

New-onset GS occurred in 10.9% of patients and was more likely with higher comorbidity burden, emergency surgery, and certain procedures. Patients with GS had markedly worse short-term trajectories including more complications, prolonged length of stay, and non-home discharge.聽

Critically, GS was associated with fewer days at home within 90 days (model-adjusted aRR ~0.73; median 66 versus 82.5 days) and more than twofold higher 1-year mortality (aHR ~2.32). Effects showed dose-response by number of GS conditions and persisted in sensitivity analyses (including when dehydration was excluded and among those without major complications).聽

For surgeons, this signals that postoperative GS should be treated as a discrete, preventable harm state that degrades patient-centered outcomes and survival. Surgeons should build perioperative pathways that anticipate and blunt common GS components, including delirium prevention and early detection, aggressive hydration and nutrition, pressure-injury avoidance, early mobilization, bowel/bladder plans, and use discharge planning that assumes elevated risk of readmission and facility placement when GS emerges.聽

Consider 鈥渄ays at home-90鈥� as a program-level quality metric alongside morbidity and mortality. Even in high-volume centers, which showed greater GS case mix yet lower 1-year mortality, proactive geriatric co-management and minimally invasive strategies where feasible may reduce GS incidence and its downstream impact.