[Is visceral surgery justified in patients over 90 years of age?].
The objective of this study was to evaluate the results of visceral surgery in patients over the age of 90 years by defining the indications, prognostic factors and short-term and intermediate results. This study was based on 50 patients operated between 1983 and 1987, consisting of 46 women and 4 men with a mean age of 92 years and a range of 90 to 98 years. 74% of the patients lived in long-stay hospitals, 26% lived at home, 28% were autonomous, 30% were semi-autonomous and 42% were bed-ridden. The majority of the patients were classified as ASA III. The mean number of visceral lesions was 3. 20% suffered from a malignant disease and 80% from a benign disease. 60% underwent emergency surgery and 40% underwent elective surgery. Postoperative complications were observed in 48% of cases, 58% of which had a fatal outcome. Sixteen patients (32%) died during the first postoperative month. The factors with a significant influence on mortality were: emergency in institutionalized patients (p less than 0.05), the ASA classification (ASA III and more, p less than 0.05), autonomy (bed-ridden patients, p less than 0.05), medical history (more than 4 associated organ defects, p less than 0.01) and malignant disease (p less than 0.001). The most pejorative complications in terms of mortality appeared to be postoperative septic shock, a pulmonary complication or a neurological complication. Cardiovascular disease, frequently reported in the history of theses patients, did not appear to specifically affect mortality. Surgery in patients over the age of 90 years appears to be justified in active patients in good general health presenting with a benign disease likely to become complicated if not treated, which should be preferably operated electively.
Imbaud
P
P
Service de Chirurgie Générale et Digestive, CHU Pitié-Salpêtrière, Paris.
Duron
J J
JJ
Sadoudi
R
R
Validire
J
J
D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D005260:Female; D005705:Gallbladder Diseases / Q000401:mortality / Q000601:surgery*; D005831:Genital Diseases, Female / Q000401:mortality / Q000601:surgery; D005832:Genital Diseases, Male / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012002:Rectal Diseases / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000401:mortality / Q000601:surgery*
La chirurgie viscérale chez les patients de plus de 90 ans est-elle licite?