title: The use of urological hospital services by nonagenarians.
abstract: BACKGROUND
  The super-elderly population is a small but expanding group of patients who will pose a significant challenge to future healthcare resources. A snapshot audit was completed of all emergency and elective urological nonagenarian activity in a UK general hospital, including surgical outcomes in this group of patients.
  
  
  METHODS
  Prospective and retrospective databases and clinical records were examined to identify all patients aged 90-99 years who had patient episodes between January 2006 and August 2012. Patient outcomes were compared with those for a similar cohort of 80-89-year-olds during the same time period.
  
  
  RESULTS
  A total of 653 nonagenarian patient episodes were identified (including 138 emergency admissions, 25 emergency surgical procedures, 71 elective surgical procedures, 173 local anaesthetic procedures and 270 outpatient visits). The in-hospital mortality rate for emergency admissions was 10%. The mean length of hospital stay was significantly longer for nonagenarians than for octogenarians (14.4 vs 6.5 days, p<0.00001). The postoperative mortality rate following emergency and elective surgery was 16% and 1% for nonagenarians and octogenarians respectively.
  
  
  CONCLUSIONS
  Nonagenarian patients often have complex medical co-morbidities and challenging social circumstances that contribute to delayed recovery from acute illness and surgery as well as long periods of hospitalisation. Adopting a multidisciplinary approach with formal input from specialist geriatric surgical services may improve patient outcomes and allow patients to be discharged to their former places of residence.
authors.affiliation: Barts Health NHS Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Pridgeon
authors.affiliation: Barts Health NHS Trust , UK.
authors.forename: E
authors.initials: E
authors.lastname: Nagarajan
authors.affiliation: Barts Health NHS Trust , UK.
authors.forename: G
authors.initials: G
authors.lastname: Ellis
authors.affiliation: Barts Health NHS Trust , UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Green
mesh_terms: D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data*
keywords: Elderly; Elective; Emergency; Nonagenarian; Surgery; Urology