Risk-adjusted general surgical audit in octogenarians.
BACKGROUND
Surgical admissions in patients more than the age of 80 years are increasing. Age-related comorbidities place this group at particular risk of complications and death. The aim of this study was to specifically document our current outcomes in patients more than 80 years old admitted to a surgical unit, in particular, to assess the risk-adjusted scoring tool used to predict outcomes in this patient population for operative and non-operative patients.


METHODS
A prospective audit of all patients older than 80 years admitted to the general surgical unit between the 1 January and 30 November 2006 was carried out. Morbidity and mortality data were collected on standardized pro forma.


RESULTS
There were 243 consecutive admissions in 223 surgical patients (readmission 8.2%, n = 20) comprising 70 emergency admissions (28.8%), 82 elective admissions (33.8%) and 91 non-operative admissions (37.5%). Complications occurred in 47.1% of emergency admissions, 18.3% of elective admissions and 23.3% of non-operative admissions. Thirty-day mortality was 15.7% (n = 11) for emergency admissions, 0% for elective admissions and 17.4% (n = 16) for non-operative admissions. Emergency laparotomy 30-day mortality was 31.6% (n = 6). There was no evidence of lack of fit when using the risk-adjusted scoring tool to compare observed with predicted deaths in all patient groups.


CONCLUSIONS
In all patients more than the age of 80 years admitted to General Surgery, Taranaki Base Hospital, morbidity and mortality results were acceptable when compared with published work. Risk-adjusted prediction of mortality compared favourably with observed outcomes, but more data are required to validate this tool in elective patients.
Nichols
Kirstin G
KG
Department of General Surgery, Taranaki Base Hospital, New Plymouth, Taranaki, New Zealand. kirstin_grace@hotmail.com
Prytherch
David R
DR
Fancourt
Micheal F
MF
Gilkison
William T C
WT
Kyle
Stephen M
SM
Mosquera
Damien A
DA
D000367:Age Factors; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology