Global Poorer Olfaction, Frailty and Postoperative Adverse Outcomes: Exploring Their Interplay in a Prospective Cohort of Older Adults Undergoing Elective Surgery
Bibliographic record
Abstract
Purpose: Olfactory dysfunction has emerged as a marker of neurodegeneration and frailty in older adults, yet its value for perioperative risk stratification remains underexplored. This prospective study aimed to assess the interplay between three olfactory modalities (Threshold, Discrimination, Identification: TDI), baseline frailty, and postoperative outcomes in older patients undergoing surgery. Patients and Methods: We enrolled adults aged 65 years or older scheduled for elective aortic/lower limb vascular or orthopedic procedures under general anesthesia. The day before surgery, patients underwent olfactory testing using the Sniffin' Sticks extended test (yielding a composite TDI score), and frailty evaluation with the Edmonton Frail Scale (EFS) and Clinical Frailty Scale. Postoperative moderate/severe complications or death occurring within one year were recorded. Statistical analyses included univariable and multivariable regression adjusted for age, sex, comorbidities, and surgical parameters. Results: percentile) was identified in 74 (35.4%) patients. Frailty (EFS ≥6/17) was present in 51 cases (24.4%). Frail patients had significantly lower TDI scores (median 25.25 vs 28.75, p<0.001), with all three modalities independently correlated with frailty after adjustment. Within one year, 54 (25.8%) experienced postoperative complications and 3 (1.4%) patients died. Reduced olfaction was associated with a higher risk of postoperative morbidity/mortality (39.2% vs 20.7%, p=0.004), and this association remained significant after accounting for age and gender, comorbidities, surgery type, and frailty. Lower olfactory performance, but not frailty, predicted poor outcomes in vascular patients (odds ratio 6.34, p=0.004), while only frailty was predictive in orthopedic patients. Conclusion: Global poorer olfaction is closely associated with frailty and may serve as a robust indicator of adverse postoperative outcomes in older adults, beyond conventional frailty scales.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".