title: Surgical care for the aged: a retrospective cross-sectional study of a national surgical mortality audit.
abstract: OBJECTIVE
  It is assumed that increased age signifies increased surgical care. Few surgical studies describe the differences in care provided to older patients compared with younger patients. We aimed to examine the relationships between increasing age, preoperative factors and markers of postoperative care in adults who died in-hospital after surgery in Australia.
  
  
  METHODS
  This retrospective cross-sectional study extracted data from a national surgical mortality audit--an independent, peer-reviewed process.
  
  
  METHODS
  From January 2009 to December 2012, 111 public and 61 private Australian hospitals notified the audit of in-hospital deaths after general anaesthetic surgery or if the patient was admitted under a surgeon.
  
  
  METHODS
  Notified deaths totalled 19,723. We excluded deaths if patients were brain dead, younger than 17 years or never had an operation (n=11,376). From this baseline population, we divided 11,201 deaths into three patient age groups: youngest (17-64 years), medium (65-79 years) and oldest (≥80 years).
  
  
  METHODS
  Univariable and multivariable logistic regression analyses determined the relationships between increasing age and the measured preoperative factors and postoperative variables.
  
  
  RESULTS
  The baseline population's median age was 78 years (IQR 66-85), 43.7% (4892/11,201) were 80 years or older and 83.4% (9319/11,173) had emergency admissions. The oldest group had increased trauma and emergency admissions than the medium and youngest age groups. Seven of the eight measured markers of postoperative care demonstrate strong and significant relationships with increasing age. The oldest group compared with the medium group had decreased rates of: unplanned returns to theatre (11.2% (526/4709) vs 20.2% (726/3586)), unplanned intensive care admissions (16.3% (545/3350) vs 24.0% (601/2504)) and treatment in intensive care units (59.7% (2689/4507) vs 76.7% (2754/3590)).
  
  
  CONCLUSIONS
  The oldest patients received lower levels of care than the medium and youngest age groups.
authors.affiliation: Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, Brisbane, Queensland, Australia School of Population Health, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Allen
authors.affiliation: Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, Brisbane, Queensland, Australia.
authors.forename: John B
authors.initials: JB
authors.lastname: North
authors.affiliation: Department of Surgery, Logan Hospital, Brisbane, Queensland, Australia.
authors.forename: Arkadiusz Peter
authors.identifier: http://orcid.org/0000-0001-6880-9285
authors.initials: AP
authors.lastname: Wysocki
authors.affiliation: School of Population Health, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.affiliation: Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, Brisbane, Queensland, Australia.
authors.forename: Therese
authors.identifier: http://orcid.org/0000-0002-6875-3565
authors.initials: T
authors.lastname: Rey-Conde
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*
keywords: aged; clinical audit; mortality; postoperative care; surgery