Rethinking preoperative risk assessment: Could biological age offer a missing clue?
Despite major improvements in perioperative care, postoperative complications still occur in patients who appear low risk based on standard assessments. Tools such as ASA classification, BMI and HbA1c provide important information, but they do not always reflect a patient’s true physiological reserve. This has led clinicians to explore biomarkers that capture long-term metabolic and vascular stress. One such biomarker is advanced glycation end products (AGEs).
Why traditional metrics may miss hidden risk
Chronological age and standard labs often overlook subtle differences in tissue quality, inflammation and vascular resilience. Two patients who appear identical on paper may recover very differently after surgery. Part of this variation may stem from metabolic aging: the cumulative burden of oxidative stress, hyperglycemia and chronic inflammation that gradually changes how tissues respond to surgical stress.
What AGEs indicate
AGEs form when sugars bind to proteins or fats and accumulate over time. Elevated AGE levels are associated with vascular stiffness, impaired endothelial function and reduced capacity for tissue repair. They are strongly linked to diabetes, cardiovascular disease and kidney impairment — all known contributors to perioperative vulnerability.
Unlike single-time biomarkers, AGE accumulation reflects long-term metabolic exposure. Measuring AGEs offers clinicians an additional lens into a patient’s chronic physiological stress.
AGEs and perioperative outcomes
Early research suggests that higher AGE levels are associated with delayed healing, postoperative infections and increased cardiovascular risk. As same-day surgery expands, unexpected readmissions remain a challenge. Patients with elevated AGEs may be more susceptible to postoperative instability despite normal standard markers, making them difficult to identify through routine screening.
Studies such as Chung et al. (2015) and Meerwaldt et al. (2005) support the idea that AGEs capture aspects of risk not visible through traditional measures, although more evidence is needed.
A complementary tool for risk stratification
Patients with elevated AGEs may be “metabolically older” than their clinical profile suggests. For perioperative teams, this raises practical considerations:
- Is same-day discharge appropriate for patients with high AGE levels?
- Could prehabilitation or closer postoperative monitoring reduce complications?
- Do patients with normal standard markers still carry hidden metabolic stress?
AGE measurement may help identify cases where additional evaluation or individualized planning is beneficial.
A fast, non-invasive measurement
The AGE Reader offers a fast, non-invasive skin autofluorescence measurement that integrates easily into preoperative workflow. Clinicians report that it supports risk conversations, highlights discrepancies between chronological and metabolic age and provides additional context when standard metrics appear normal.
Adding depth to preoperative evaluation
Perioperative teams aim to improve outcomes while reducing avoidable readmissions. Incorporating an indicator of tissue-level vulnerability may strengthen risk stratification, particularly in older adults and patients with chronic disease. While ongoing studies will determine the precise role of AGEs in perioperative care, early evidence suggests that they offer meaningful complementary insight into a patient’s physiological resilience.