Abstract or Summary
Recent advances in risk stratification have led to improvements in our ability to predict complications, cost and outcomes. Chronological age is important in almost all risk calculators; however, genetic or biological age may be more informative. Several techniques exist to assess genetic age including DNA methylation patterns with epigenetic clocks, telomere length and analysis of both mitochondrial DNA and single nucleotide polymorphisms. Our lab recently demonstrated a novel association between telomere length and 90-day complications in adult deformity surgery. There are no current risk stratification tools that integrate markers of cellular aging or biophysiologic reserve. Determining the optimal aging biomarkers to include in risk assessment models will be critical to future work in preoperative risk assessment.