Surgery in nonagenarians: morbidity, mortality, and functional outcome

Abstract

Background: There are few studies that document the outcomes experienced by very old patients who undergo major surgery.

Methods: This is a case series and 7-year follow-up of 116 consecutive patients who were aged 90 years or older and underwent major surgery at a large university-affiliated community hospital. We describe the functional status, short- and long-term mortality, and predictors of mortality in this group of frail elders.

Results: The 116 nonagenarians in this study underwent 134 major operations. Sixty-three patients were admitted to the hospital from a nursing home. The most common surgical procedures were for hip fracture, lower extremity amputation, and abdominal problems. Nineteen patients died in the hospital following surgery, and 23 patients died within 30 days of operation. Follow-up at 7 years revealed that all but three patients had died. Survival was worse for patients admitted from nursing homes, those who were nonambulatory before surgery, and those with major or complete functional impairment.

Conclusions: Major surgery in nonagenarians is associated with a 20% perioperative mortality. Functional status and ambulatory ability are maintained in most patients. Whether to operate on these frail elders is a complex decision.