Surgery in the very old patient: evaluation of factors linked to postoperative morbidity and mortality.
One hundred and sixty-seven patients over 79 years of age were studied prospectively in our Emergency Surgery Department in order to evaluate their outcome, and the possible existence of factors linked to morbidity and mortality. The most common indications for surgery were gallstones (22.1%), hernias (14.9%), colo-rectal cancer (13.7%), peptic ulcer (6.5%), gastric cancer (5.9%) and ischemic or hemorrhagic vascular diseases (13.1%). Emergency surgery was performed in 93 (55.6%) patients. Forty-nine patients (29.3%) developed 83 postoperative complications. The risk of morbidity was statistically higher in patients who had more than two associated diseases (p < 0.05) and received blood transfusions (p < 0.01). The mortality rate was 16.1%, and was significantly related to ASA scores > or = 4 (p < 0.001) and a high degree of intraoperative bacterial contamination (Classes III-IV) (p < 0.05). Compared to elective surgery emergency operations had a higher morbidity (33.3% vs 24.3%) and mortality (21.5% vs 9.4%), but the difference was not significant. Mortality/morbidity ratio was significantly higher in emergency, as compared to elective surgery (64.5% vs 38.8%, p < 0.001).
Di Palo
S
S
San Raffaele Scientific Institute, Emergency Surgery Department, University of Milano, Italy.
Giangreco
L
L
Vignali
A
A
Carlucci
M
M
Staudacher
C
C
D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality*; D016896:Treatment Outcome