Impact of advancing age on abdominal surgical outcomes

Abstract

Objective: To describe the population-level risk of adverse outcomes among older adults undergoing common abdominal surgical procedures.

Design: Retrospective, population-based cohort study.

Setting: Washington State hospital discharge database.

Participants: A total of 101 318 adults 65 years or older who underwent common abdominal procedures such as cholecystectomy, colectomy, and hysterectomy from 1987 through 2004.

Main outcome measures: Ninety-day rates of postsurgical morbidity and mortality.

Results: The 90-day cumulative incidence of complications was 17.3%, with a 90-day mortality rate of 5.4%. Advancing age was associated with increasing frequency of complications (65-69 years, 14.6%; 70-74 years, 16.1%; 75-79 years, 18.8%; 80-84 years, 19.9%; 85-89 years, 22.6%; and >or=90 years, 22.7%; trend test, P < .001) and mortality (65-69 years, 2.5%; 70-74 years, 3.8%; 75-79 years, 6.0%; 80-84 years, 8.1%; 85-89 years, 12.6%; and >or=90 years, 16.7%; trend test, P < .001). After adjusting for demographic, patient, and surgical characteristics as well as hospital volume, the odds of early postoperative death increased considerably with each advance in age category. These associations were found among patients with both cancer and noncancer diagnoses and for both elective and nonelective admissions (trend test, P < .001).

Conclusions: Among older adults, the risk of complications and early death after commonly performed abdominal procedures is greater than previously reported. These rates should be considered in ongoing quality improvement initiatives and may be helpful when counseling patients regarding abdominal operations.