Postoperative outcome among elderly patients after general anesthesia.
BACKGROUND
Preoperative decision-making for elderly patients requires a long-term perspective. The aim of this study was to identify preoperative risk factors for decreased 1- to 5-year survival rates and to compare the survival rates of stratified risk groups with those of the sex- and age-matched general population.


METHODS
Subjects were 406 patients, aged 80 years or older, who underwent surgery with general anesthesia. Higher age, male sex, dependency in daily living, low serum albumin level, malignancy, abdominal surgery, emergency surgery and high ASA class were analyzed for survival using univariate and multivariate analysis with Cox's proportional hazard model. One- to 5-year survival rates were estimated using life table analysis for patients divided by risk factors. The survival data were also compared with the cumulative survival rates of the sex- and age-matched general population.


RESULTS
Multivariate analysis identified three factors that were significantly associated with decreased survival rates: male sex, dependency in daily living and abdominal surgery. Long-term survival among patients older than 90 years was comparable to those of the general population. Although improved in recent years, overall survival rates were much lower than expected due to poor outcome among patients dependent in daily living and those who underwent abdominal surgery.


CONCLUSIONS
In patients 80 years or older who underwent surgery with general anesthesia, independent risk factors for decreased survival are male sex, dependency in daily living and abdominal surgery. Only patients independent in daily living who underwent non-abdominal surgery had survival rates comparable to those of the general population.
Kojima
Y
Y
Department of Anesthesiology, Suwa Red Cross Hospital, and Department of Anesthesiology and Reanimatology, Shinshu University School of Medicine, Nagano, Japan. fayuko33@hotmail.com
Narita
M
M
D000005:Abdomen / Q000601:surgery; D000203:Activities of Daily Living; D000367:Age Factors; D000369:Aged, 80 and over; D000768:Anesthesia, General; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013514:Surgical Procedures, Operative / Q000401:mortality*; D015996:Survival Rate
D012709:Serum Albumin