Major abdominal surgery in octogenarians.
OBJECTIVE
To evaluate long-term survival after major abdominal surgery in patients who are 80 years and over and to assess possible predictors of outcome: age, acute vs elective surgery, associated comorbidities and type of surgical procedure.


METHODS
Patients who had surgery between 1 July 1997 and 1 July 1999 were reviewed. We reviewed 30-day mortality, major complications, hospital stay, intensive care unit (ICU) stay and long-term survival. General practitioners (GPs), family members or patients were contacted.


RESULTS
One hundred and eighty patients had surgery, median age 84 (80-97), 115 females. Seventeen patients were lost to follow up. One hundred had an emergency procedure and 80 had elective procedures. Thirty-day mortality with emergency procedures was 29% and with elective operations, 7.5 % (p <0.0001). Overall morbidity was 33.3%. Long-term survival data were analysed using Kaplan-Meier survival curves and compared with the age-matched population obtained from Statistics New Zealand. They showed that long-term survival is similar between emergency and elective procedures after adjustment for peri-operative mortality. There was no survival difference between procedures.


CONCLUSIONS
Elective surgery is generally well tolerated by the elderly. There is high in-hospital morbidity and mortality in the emergency group; however, long-term survival in those patients who leave hospital is not significantly different to the age-adjusted population. Age should not be used as the only criterion when deciding suitability for surgery in this age group.
Department of Surgery, North Shore Hospital, Takapuna, Auckland, New Zealand. Salehabbas@clear.net.nz
Saleh
S
Abbas
Michael
M
Booth
D000005:Abdomen / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D004630:Emergencies; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D016019:Survival Analysis