Surgical care in octogenarians

The general surgical profile of octogenarians compared with that of younger patients, and risk factors predictive of operative mortality and morbidity, were determined retrospectively using a computer database for all patients admitted between 1989 and 1993. There were 934 admissions of octogenarians and surgery was performed in 447 cases (47.9 per cent). The admission rate of patients over 80 years of age increased during the 5-year period from 4.6 to 9.0 per cent, and was significantly higher than that of geriatric patients aged 65-79 years (P<0.01). Emergency admissions (63.6 per cent) and operations (42.3 per cent) were more frequent in patients aged over 80 years (P<0.01); emergency operations increased during the 5 years from 38 to 59 per cent. Altogether, 83 deaths and 171 complications were recorded. The mortality rate of octogenarians was greater than that of younger patients (P<0.01). Postoperative mortality and morbidity rates were 10.1 and 32.2 per cent respectively. After multiple logistic regression analysis with stepwise backward elimination, an American Society of Anesthesiologists score of II-V (P<0.01), the presence of two associated diseases (P<0.01) and laparotomy procedures (P<0.03) appeared to be independent risk factors for postoperative mortality and morbidity.