title: The differential effects of surgical harm in elderly populations. Does the adage: "they tolerate the operation, but not the complications" hold true?
abstract: BACKGROUND
  Elderly patients are thought to tolerate surgical complications poorly because of low physiologic reserve. The purpose of the study was to evaluate the differential effects of surgical harm in patients over 80 years old.
  
  
  METHODS
  Three years of data from a harm-reduction campaign were used to identify inpatient surgeries performed on patients older than 50. The rates of harm, death, cost, and length of stay (LOS) were analyzed using SPSS 21 (IBM, New York, NY).
  
  
  RESULTS
  A total of 22,710 patients were identified. Rates of harm and mortality increased with increasing age. Harmed patients over age 80 had increased mortality (9.5% vs 7%), but lower cost, intensive care unit days, and LOS versus those aged 50 to 80. Linear regression showed increased cost with harm ($24,000) and decreased cost with age above 80 (-$7,000).
  
  
  CONCLUSIONS
  In the elderly surgical population, there is more harm and harm events are associated with higher mortality rates, but less additional cost and LOS. Differing goals or aggressiveness of care may explain cost avoidance in the elderly.
authors.affiliation: Department of Surgery, Henry Ford Health System, Detroit, MI, USA. Electronic address: padams6@hfhs.org.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Adams
authors.affiliation: Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ritz
authors.affiliation: Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kather
authors.affiliation: Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Pat
authors.initials: P
authors.lastname: Patton
authors.affiliation: Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Jordan
authors.affiliation: Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Roberta
authors.initials: R
authors.lastname: Mooney
authors.affiliation: Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Harriette Mathilda
authors.initials: HM
authors.lastname: Horst
authors.affiliation: Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Ilan
authors.initials: I
authors.lastname: Rubinfeld
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D005260:Female; D040261:Harm Reduction; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000523:psychology*
keywords: Cost; Elderly; Harm; Outcomes