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Observational Study
. 2024 Mar 10;36(1):64.
doi: 10.1007/s40520-024-02717-7.

Perioperative outcome, long-term mortality and time trends in elderly patients undergoing low-, intermediate- or major non-cardiac surgery

E K M Tjeertes  1   2 , T F W Simoncelli  1 , A J M van den Enden  1 , F U S Mattace-Raso  3 , R J Stolker  1 , S E Hoeks  4
Affiliations
Observational Study

Perioperative outcome, long-term mortality and time trends in elderly patients undergoing low-, intermediate- or major non-cardiac surgery

E K M Tjeertes et al. Aging Clin Exp Res. .

Abstract

Background: Decision-making whether older patients benefit from surgery can be a difficult task. This report investigates characteristics and outcomes of a large cohort of inpatients, aged 80 years and over, undergoing non-cardiac surgery.

Methods: This observational study was performed at a tertiary university medical centre in the Netherlands. Patients of 80 years or older undergoing elective or urgent surgery from January 2004 to June 2017 were included. Outcomes were length of stay, discharge destination, 30-day and long-term mortality. Patients were divided into low-, intermediate and high-risk surgery subgroups. Univariable and multivariable logistic regression were used to evaluate the association of risk factors and outcomes. Secondary outcomes were time trends, assessed with Mantel-Haenszel chi-square test.

Results: Data of 8251 patients, undergoing 19,027 surgical interventions were collected from the patients' medical record. 7032 primary procedures were suitable for analyses. Median LOS was 3 days in the low-risk group, compared to six in the intermediate- and ten in the high-risk group. Median LOS of the total cohort decreased from 5.8 days (IQR 1.9-14.5) in 2004-2007 to 4.6 days (IQR 1.9-9.0) in 2016-2017. Three quarters of patients were discharged to their home. Postoperative 30-day mortality in the low-risk group was 2.3%. In the overall population 30-day mortality was high and constant during the study period (6.7%, ranging from 4.2 to 8.4%).

Conclusion: Patients should not be withheld surgery solely based on their age. However, even for low-risk surgery, the mortality rate of more than 2% is substantial. Deciding whether older patients benefit from surgery should be based on the understanding of individual risks, patients' wishes and a patient-centred plan.

Keywords: Discharge destination; Elderly patients; Length of stay; Mortality; Surgery; Surgical risk.

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Conflict of interest statement

This manuscript has been submitted solely to this journal and is not in press or submitted elsewhere. Parts of this manuscript have been published in the author’s thesis [33]. All authors have read and approved the manuscript. There is no commercial association that might pose a conflict of interest relevant to this paper.

Figures

Fig. 1
Fig. 1
Longterm survival according to surgocal risk category
Fig. 2
Fig. 2
Boxplot length of stay over time, stratified per risk category
Fig. 3
Fig. 3
Discharge destination over time
See this image and copyright information in PMC

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