With the aging population and the widespread implementation of lung cancer screening programs, an increasing number of elderly patients are undergoing curative lung resection. Due to diminished physiological reserve and complex comorbidities, this demographic exhibits a significantly higher incidence of severe perioperative complications (defined as Clavien-Dindo grade≥Ⅲ), which adversely affects both perioperative safety and long-term prognosis. In recent years, the research paradigm has shifted from univariate analysis toward multidimensional risk integration and the development of predictive models. This article systematically reviews the key risk factors for severe perioperative complications in elderly lung cancer patients, encompassing biological aging processes, frailty and sarcopenia, cardiopulmonary and renal functional reserves, inflammatory-immune and coagulation status, and perioperative interventions. Furthermore, it traces the evolution of risk assessment tools from traditional regression models to machine learning models that integrate multimodal data. The review also discusses common challenges in this field, including the standardization of outcome definitions, external validation, calibration assessment, and clinical translation. Future efforts should prioritize the deep integration of predictive tools with clinical decision support systems to establish a closed-loop care pathway from risk identification to stratified intervention, thereby effectively reducing complication rates and enhancing surgical outcomes for elderly lung cancer patients.

Objective:To identify the risk factors for perioperative cardiac arrest (POCA) in elderly patients undergoing general anesthesia.Methods:This case-control study enrolled elderly patients aged ≥60 yr who underwent surgery under general anesthesia at Peking Union Medical College Hospital between January 1, 2013, and November 30, 2024. The case group consisted of patients who experienced POCA, defined as cessation of cardiac mechanical activity and loss of effective circulation, requiring immediate chest compressions and/or defibrillation within 24 h from entering the operating room to the end of anesthesia. The control group consisted of elderly patients without POCA, matched to cases by sex and date of surgery in a ratio of 1∶3. Univariate analysis and multivariate logistic regression were performed to identify independent risk factors for POCA based on patients′ baseline and surgical characteristics.Results:A total of 53 POCA cases and 159 matched controls were included. The results of multivariate logistic regression analysis identified an American Society of Anesthesiologists Physical Status classification of ≥Ⅲ ( OR=4.90, 95% confidence interval [ CI] 2.21-10.89, P<0.001) and the presence of peripheral vascular disease ( OR=2.53, 95% CI 1.10-5.81, P=0.028) as independent risk factors for POCA. Higher preoperative hemoglobin concentration was found to be a protective factor ( OR=0.97, 95% CI 0.95-0.99, P<0.001). Conclusions:An American Society of Anesthesiologists Physical Status classification of ≥Ⅲ and comorbid peripheral vascular disease are independent risk factors for POCA in elderly patients undergoing general anesthesia, while higher preoperative hemoglobin concentration serves as a protective factor.

Objective:To identify the risk factors for perioperative cardiac arrest (POCA) in elderly patients undergoing general anesthesia.Methods:This case-control study enrolled elderly patients aged ≥60 yr who underwent surgery under general anesthesia at Peking Union Medical College Hospital between January 1, 2013, and November 30, 2024. The case group consisted of patients who experienced POCA, defined as cessation of cardiac mechanical activity and loss of effective circulation, requiring immediate chest compressions and/or defibrillation within 24 h from entering the operating room to the end of anesthesia. The control group consisted of elderly patients without POCA, matched to cases by sex and date of surgery in a ratio of 1∶3. Univariate analysis and multivariate logistic regression were performed to identify independent risk factors for POCA based on patients′ baseline and surgical characteristics.Results:A total of 53 POCA cases and 159 matched controls were included. The results of multivariate logistic regression analysis identified an American Society of Anesthesiologists Physical Status classification of ≥Ⅲ ( OR=4.90, 95% confidence interval [ CI] 2.21-10.89, P<0.001) and the presence of peripheral vascular disease ( OR=2.53, 95% CI 1.10-5.81, P=0.028) as independent risk factors for POCA. Higher preoperative hemoglobin concentration was found to be a protective factor ( OR=0.97, 95% CI 0.95-0.99, P<0.001). Conclusions:An American Society of Anesthesiologists Physical Status classification of ≥Ⅲ and comorbid peripheral vascular disease are independent risk factors for POCA in elderly patients undergoing general anesthesia, while higher preoperative hemoglobin concentration serves as a protective factor.