Original scientific article
Surgical Risk Factors, Morbidity, and Mortality in Elderly Patients

Presented at the Symposium “Surgery in the Elderly Patient, Galveston III,” Galveston, TX, April 2006. This symposium was generously supported by Genitzinger Endowment Fund, the Sealy Center for Aging and the Department of Surgery, UTMB, and the American Geriatric Society.
https://doi.org/10.1016/j.jamcollsurg.2006.08.026Get rights and content

Background

The aging population of the United States results in increasing numbers of surgical operations on elderly patients. This study observed aging related to morbidity, mortality, and their risk factors in patients undergoing major operations.

Study design

We reviewed our institution’s American College of Surgeons National Surgical Quality Improvement Program database from February 24, 2002, through June 30, 2005, including standardized preoperative, intraoperative, and 30-day postoperative data points. This required review and analysis of the prospectively collected data. We examined patient demographics, preoperative risk factors, intraoperative risk factors, and 30-day outcomes with a focus on those aged 80 years and older.

Results

A total of 7,696 surgical procedures incurred a 28% morbidity rate and 2.3% mortality rate, although those older than 80 years of age had a morbidity of 51% and mortality of 7%. Hypertension and dyspnea were the most frequent risk factors in those aged 80 years and older. Preoperative transfusion, emergency operation, and weight loss best predicted morbidity for those 80 years of age and older. Operative duration predicted “other” postoperative occurrences and emergent case status predicted respiratory occurrences across all age groups. Preoperative impairment of activities of daily living, emergency operation, and increased American Society of Anesthesiology classification predicted mortality across all age groups. A 30-minute increment of operative duration increased the odds of mortality by 17% in patients older than 80 years. Postoperative morbidity and mortality increased progressively with increasing age. Age was statistically significantly associated with morbidity (wound, p = 0.021; renal, p = 0.001; cardiovascular, p = 0.0004; respiratory, p < 0.0001) and mortality (p = 0.001).

Conclusions

Although several risk factors for postoperative morbidity and mortality increase with age, increasing age itself remains an important risk factor for postoperative morbidity and mortality.

Section snippets

Methods

The University of Virginia Health System Institutional Review Board approved this study. The NSQIP, developed in the Veterans Administration, provided the well-described definitions and methodology.18, 19 The University of Virginia Health System has participated in the NSQIP from February 24, 2002, to the present. Surgical Clinical Nurse Reviewers systematically record preoperative, intraoperative, and postoperative variables of surgical patients. Previous publications provide detailed

Results

We recorded 7,916 major surgical procedures in the University of Virginia Health System ACS-NSQIP data set, and 7,696 eligible procedures were performed on 6,953 patients. One thousand seven hundred one (1,701) patients underwent multiple procedures (range 2 to 13), with 220 occurring during the same hospitalization, and were removed. Emergent operations accounted for 16% (1,198 of 7,696) of procedures; 24% (1,815 of 7,696) of patients did not have a preoperative risk factor; and female

Discussion

Increasing age itself is an important risk factor for surgical candidates. Surgical morbidity exhibited a linear increase across all age groups. Between ages 18 and 69, morbidity rate and risk factors increased similarly by increments with age. At ages 70 and older, morbidity increased by decade without increasing preoperative risk factors. Surgical mortality increased exponentially across all age groups when morbidity exhibited linear increases and when preoperative risk factors ceased

Acknowledgment

We thank Clifford Y Ko, MD, MS, MSHS, for his critical review of this article; Bart D Phillips, BS, for calculating the mortality rate equation; and William G Henderson, PhD, MPH for sharing the development of the NSQIP’s statistical model.

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    Competing Interests Declared: None.

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    Copyright © 2006 American College of Surgeons. Published by Elsevier Inc. All rights reserved.