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Peer-reviewedCC BY-NC-ND 4.0NPJ Aging

Biological aging increases risk of postoperative morbidity and mortality: an international, multi-cohort study

  • Joseph R. Scarpa1,2
  • M. Cary Reid3
  • Olivier Elemento2
  • Jan Krumsiek2,4
4 affiliations
  1. 1Department of Anesthesiology, Weill Cornell Medicine, New York, NY USA
  2. 2Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY USA
  3. 3Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY USA
  4. 4Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY USA
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Abstract

Biological age often diverges from chronological age, yet its independent impact on surgical outcomes remains poorly defined. We evaluated PhenoAge, a validated biological age metric, in an international multi-cohort study comprising over 430,000 surgical patients across the UK, USA, and South Korea. In the UK Biobank (N = 291,845), PhenoAge was a robust, independent predictor of 1-year mortality (OR 1.043; p < 0.001), major adverse cardiovascular events (OR 1.041; p < 0.001), and 30-day readmission (OR 1.02; p < 0.001), even after adjusting for chronological age, Fried Frailty Index, Charlson comorbidity score, American Society of Anesthesiologists (ASA) physical status, surgical complexity, and other common surgical risk factors. “Fast Agers” faced a 49% higher risk of mortality than “Normal Agers”. The main findings were replicated across three independent international cohorts (MOVER OR 1.03; Weill Cornell OR 1.036; INSPIRE OR: 1.05; all p < 0.001), and validated prospectively at a large academic medical center, where PhenoAge predicted acute 3-day complications (OR 1.20; p = 0.015). As a scalable tool leveraging routine laboratory data, PhenoAge facilitates precision gerisurgery by identifying high-risk individuals for prehabilitation and biologically resilient candidates for complex procedures regardless of chronological age.

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Cite

BibTeXRIS
BibTeX
@article{scarpa2026biological,
  title = {{Biological aging increases risk of postoperative morbidity and mortality: an international, multi-cohort study}},
  author = {Joseph R. Scarpa and M. Cary Reid and Olivier Elemento and Jan Krumsiek},
  journal = {NPJ Aging},
  year = {2026},
  month = jul,
  doi = {10.1038/s41514-026-00441-2},
  url = {https://doi.org/10.1038/s41514-026-00441-2},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Biological aging increases risk of postoperative morbidity and mortality: an international, multi-cohort study
AU  - Joseph R. Scarpa
AU  - M. Cary Reid
AU  - Olivier Elemento
AU  - Jan Krumsiek
PY  - 2026
DA  - 2026/07/04
JO  - NPJ Aging
DO  - 10.1038/s41514-026-00441-2
UR  - https://doi.org/10.1038/s41514-026-00441-2
AB  - Biological age often diverges from chronological age, yet its independent impact on surgical outcomes remains poorly defined. We evaluated PhenoAge, a validated biological age metric, in an international multi-cohort study comprising over 430,000 surgical patients across the UK, USA, and South Korea. In the UK Biobank (N = 291,845), PhenoAge was a robust, independent predictor of 1-year mortality (OR 1.043; p < 0.001), major adverse cardiovascular events (OR 1.041; p < 0.001), and 30-day readmission (OR 1.02; p < 0.001), even after adjusting for chronological age, Fried Frailty Index, Charlson comorbidity score, American Society of Anesthesiologists (ASA) physical status, surgical complexity, and other common surgical risk factors. “Fast Agers” faced a 49% higher risk of mortality than “Normal Agers”. The main findings were replicated across three independent international cohorts (MOVER OR 1.03; Weill Cornell OR 1.036; INSPIRE OR: 1.05; all p < 0.001), and validated prospectively at a large academic medical center, where PhenoAge predicted acute 3-day complications (OR 1.20; p = 0.015). As a scalable tool leveraging routine laboratory data, PhenoAge facilitates precision gerisurgery by identifying high-risk individuals for prehabilitation and biologically resilient candidates for complex procedures regardless of chronological age.
SN  - 2731-6068
ER  -