Predicting adverse postoperative outcomes in patients aged 80 years or older.
OBJECTIVE
The identification of reversible factors that are associated with postoperative morbidity in geriatric surgical patients is critical to improving perioperative outcomes in such patients. Our study aimed to compare the relative importance of intraoperative versus preoperative factors in predicting adverse postoperative outcomes in geriatric patients.


METHODS
Retrospective cohort study of consecutive patients undergoing noncardiac surgery in 1995.


METHODS
Two University of California, San Francisco, teaching hospitals--Moffitt/Long and Mount Zion medical centers.


METHODS
All men and women 80 years of age or older undergoing noncardiac surgery.


METHODS
Medical records of all patients were reviewed to measure predefined pre- and intraoperative risk factors and postoperative outcomes. Predictors of postoperative outcomes were identified by multivariate logistic regression analyses.


RESULTS
Three hundred sixty-seven patients were studied. The most prevalent preoperative risk factors were a history of hypertension and coronary artery, pulmonary, and neurologic diseases. Postoperative in-hospital mortality rate was 4.6%, and 25% of patients developed adverse postoperative outcomes, of which neurological and cardiovascular complications were the leading causes of morbidity (15% and 12%, respectively). By multivariate logistic regression, a history of neurological disease (odds ratio [OR] 4.0, 95% confidence interval [CI] 2.3 - 6.9, P = .0001), congestive heart failure (OR 2.7, 95% CI 1.4 - 5.3, P = .004), and a history of arrhythmia (OR 2.3, 95% CI 1.2 - 4.3, P = .01) increased the odds of adverse postoperative events. The only intraoperative event shown to be predictive of postoperative complications was the use of vasoactive agents (OR 8.0, 95% CI 1.6 - 40.5, P = .009).


CONCLUSIONS
In this group of geriatric surgical patients, the overall postoperative in-hospital mortality rate was 4.6%, and 25% of the patients developed adverse postoperative outcomes involving either the neurological, cardiovascular, or pulmonary systems. Intraoperative events appeared to be less important than preoperative comorbidities in predicting adverse postoperative outcomes.
Liu
L L
LL
Department of Anesthesia, University of California, San Francisco, USA.
Leung
J M
JM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D012737:Sex Factors; D013514:Surgical Procedures, Operative