title: Elective and emergency abdominal surgery in patients 90 years of age or older.
abstract: BACKGROUND
  Few studies have examined perioperative outcomes in nonagenarians undergoing abdominal surgery, and fewer have reported on 1-year mortality. Our objectives were to determine the outcomes of abdominal surgery in nonagenarians and to assess the performance of Physiologic and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (p- POSSUM) as predictors of mortality.
  
  
  METHODS
  We conducted a retrospective chart review of all patients 90 years and older who underwent abdominal surgery between 2000 and 2007 at a tertiary care hospital.
  
  
  RESULTS
  We included 145 patients (median age 91, range 90-101 yr). The most common diagnoses were colorectal cancer (19.3%) and hernias (19.3%), and the most common procedures were bowel resection with anastomosis (25.5%) and hernia repair (18.6%). Overall in-hospital mortality was 15.2% (20.8% in the emergent group and 9.6% in the elective group; p = 0.06). The 1-year mortality (49.1% v. 27.8%; p = 0.016), complication (81.9% v. 61.6%; p = 0.007) and intensive care unit admission rates (44.4% v. 11.0%; p < 0.001) were significantly higher among emergent than elective surgical patients. The operative indications and procedures associated with the highest in-hospital mortality were large bowel obstruction (42.3%) and bowel resection with anastomosis (27.0%). Both the POSSUM and p-POSSUM scoring systems significantly overpredicted mortality, particularly in higher risk groups.
  
  
  CONCLUSIONS
  Nonagenarians undergoing abdominal surgery have substantial operative morbidity and mortality, particularly in emergent surgical cases. Nearly 50% of patients who undergo emergency procedures die within 1 year after surgery. The POSSUM and p-POSSUM scoring systems were not reliable predictors of in-hospital mortality.
authors.affiliation: Department of Surgery, London Health Sciences Centre, the University of Western Ontario, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Racz
authors.forename: Luc
authors.initials: L
authors.lastname: Dubois
authors.forename: Adam
authors.initials: A
authors.lastname: Katchky
authors.forename: William
authors.initials: W
authors.lastname: Wall
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000401:mortality*; D004638:Emergency Treatment / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008131:London; D008297:Male; D008499:Medical Records; D011237:Predictive Value of Tests; D012189:Retrospective Studies