Major abdominal surgery in octogenarians

Abstract

Aims: To evaluate long-term survival after major abdominal surgery in patients who are 80 years and over and to assess possible predictors of outcome: age, acute vs elective surgery, associated comorbidities and type of surgical procedure.

Methods: Patients who had surgery between 1 July 1997 and 1 July 1999 were reviewed. We reviewed 30-day mortality, major complications, hospital stay, intensive care unit (ICU) stay and long-term survival. General practitioners (GPs), family members or patients were contacted.

Results: One hundred and eighty patients had surgery, median age 84 (80-97), 115 females. Seventeen patients were lost to follow up. One hundred had an emergency procedure and 80 had elective procedures. Thirty-day mortality with emergency procedures was 29% and with elective operations, 7.5 % (p <0.0001). Overall morbidity was 33.3%. Long-term survival data were analysed using Kaplan-Meier survival curves and compared with the age-matched population obtained from Statistics New Zealand. They showed that long-term survival is similar between emergency and elective procedures after adjustment for peri-operative mortality. There was no survival difference between procedures.

Conclusions: Elective surgery is generally well tolerated by the elderly. There is high in-hospital morbidity and mortality in the emergency group; however, long-term survival in those patients who leave hospital is not significantly different to the age-adjusted population. Age should not be used as the only criterion when deciding suitability for surgery in this age group.