Tumour resection conferred a survival advantage. Wider use of laparoscopy is advocated. Improved selection for surgery should result in a lower mortality rate.
SummaryA prospective 5-year survival study of 900 patients, aged 65 years and over, undergoing a general surgical procedure. demonstrated that following an initial high mortality rate the survival of the group as a whole approached that of an age-matched population. Non-elective admissions, age 75 years and over, ASA grade 4 5 and major surgery were associated with a high early mortality. Mortality associated with malignancy extended over 1 year. The study reinforces the conclusion that age alone should be no bar to surgery and anaesthesia, endorses the findings of the National Conjidential Enquiry into Peri-operative deaths and emphasises the need to re-examine the provision of anaesthetic and surgical services in District General Hospitals. The henefts of elective admission in the very old are highlighted, along with the potential for extension of day case surgery. Key wordsAge factors. Anaesthesia; geriatric. Surgery.Many changes have occurred in surgical and anaesthetic practice over the past 20 years, with a growing number of operations of increasing complexity being undertaken in older and often less fit, patients [I]. While much is known about the early postoperative outcome of elderly general surgical patients, little has been published on their long-term survival since the two studies of Andersen and Ostberg [2, 31 more than two decades ago. This present study has, therefore, been undertaken to establish the trends of long-term survival in general surgical patients aged 65 years and over and to identify those factors of importance in predicting outcome. Patients and methodsThe Maelor Hospital, Wrexham, is a District General Hospital which at the time of the study served a population of 228 000 of whom 14.3% were aged 65 years and over. As described in a previous prospective study of hospital outcome [4], a detailed pre-operative questionnaire was completed by the surgeons and anaesthetists involved in the care of each patient aged 65 years and over, who underwent a general surgical operation during the 12 month period from May 1985. These included urological operations but excluded endoscopic investigations of the gastro-intestinal tract [4]. Orthopaedic and trauma cases were not included. In addition to general medical information, the ASA status of each patient was established pre-operatively .Three years after surgery an interim personal questionnaire was sent to those patients discharged from hospital who were not known to have subsequently died. This was accompanied by a letter explaining the reasons for the request and apologising should the patient be then deceased. If replies were not received, further enquiries to ascertain survival were undertaken using the general practitioners, the Family Practitioner Service, the local Registrar of Births and Deaths, the NHS Central Register at Southport and the office of Population Censuses and Surveys, London. A further follow up was undertaken 5 years postoperatively.
Patients were generally happy with their surgical care and there was little difference between the three hospitals studied. Lower scores were given when patients were admitted to emergency admission wards. Higher scores were given when patients received printed information.
This survey reviews 815 consecutive patients undergoing surgery for benign biliary disease. There were no deaths following elective operations and the overall mortality was 0.7 per cent. One-third of patients had one or more complications. The mortality in patients having common bile duct exploration (n = 160) by one or more methods was 2.5 per cent (4 patients) with 46 per cent of these patients having complications. Of 95 patients undergoing duct exploration and postoperative T-tube cholangiography, 7 had unexpected residual calculi after initial cholecystectomy. Five have had further surgery to clear the duct. All patients having duct surgery alone for retained stones (n = 24) had previously had cholecystectomy with or without supraduodenal duct exploration. Of all patients undergoing choledochoduodenostomy or transduodenal sphincter exploration only one has returned with evidence of retained calculi. Patients with choledocholithiasis were examined in an attempt to identify a high risk group. These were found to be elderly patients, having emergency surgery for sepsis and on whom more than one duct procedure was performed (mortality 10 per cent).
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