Major abdominal surgery in octogenarians: should high age affect surgical decision-making?
BACKGROUND
Over the last decades longevity has increased significantly, with more octogenarians undergoing surgery. Here, we assess surgical outcomes after major abdominal surgery in octogenarians.


METHODS
Observational cohort of 874 patients undergoing major abdominal elective surgery between January 2009 and March 2014. Seventy-six octogenarians were propensity matched to 76 younger patients, corrected for sex, body mass index, American Society of Anesthesiologists classification, comorbidity, indication, and type of surgery.


RESULTS
Minor complications were more prevalent in octogenarians (P = .01) and consisted mainly of respiratory complications; progressing to respiratory insufficiency requiring intubation in 28.6%. Preoperative weight loss (odds ratio 3 [1.1 to 8.3]) and upper gastrointestinal surgery (odds ratio 11 [2 to 60]) were associated with minor complications.


CONCLUSIONS
Octogenarians are at increased risk of minor complications after major abdominal surgery. Major complication rates were similar, indicating the importance of preoperative assessment and standardized surgical techniques. Taking into account preoperative morbidities and type of surgery and techniques. Implementation of quality control algorithms may further improve outcomes in octogenarians.
Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. Electronic address: je.straatman@vumc.nl.
Jennifer
J
Straatman
Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Nicole
N
Van der Wielen
Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Miguel A
MA
Cuesta
Department of Epidemiology and Biostatistics, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
Elly S M
ES
de Lange-de Klerk
Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Donald L
DL
van der Peet
D000005:Abdomen / Q000601:surgery; D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000379:methods / Q000401:mortality*; D005260:Female; D016330:Frail Elderly; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
Elderly; Major abdominal surgery; Octogenarians; Postoperative complications