Comparison of Mortality Rates for Various Surgical Operations According to Age Groups, 1951–1977*

Abstract

A comparison was made of the mortality rates for various surgical operations, by age groups and by time periods. The age groups were: under 60, 60-69, 70-79, and 80 or over. The three time periods were: 1951-1955, 1956-1967, and 1967-1977. Only slight improvement was noted in these mortality rates despite the fact that during the 1951-1977 period many improvements were made in anesthesia, surgical techniques, antibiotic therapy, intensive-care units, and presumably the better understanding of disease. Further improvements will depend almost exclusively upon studying the basic problems of old age, chiefly atherosclerosis with its effects on the heart, blood vessels, brain, respiratory system and urinary tract. Unless this is done, there is no prospect of great improvement in operative results, and no basis for believing that the operative risk in the aged is the same as in the young. Unless the physiologic reserves of the aged can be improved, the surgical mortality rates likely will remain static.

Mortality after gynaecologic operations in Finland, 1986–1991

“…The cumulative age‐adjusted mortality rates by 42 days showed that the risk of dying after abdominal hysterectomy is greater than after vaginal hysterectomy, especially among postmenopausal women. This is consistent with some (Ziffren 1979; Dicker et al 1982; Wingo et al 1985; Kjerulff et al 1993) but not all (White et al 1971; Ledger & Child 1973; Amirikia & Evans 1979) previous reports. In Finland, as in the other Scandinavian countries (Loft et al 1991; Helström et al 1993), vaginal hysterectomy is generally performed for pelvic relaxation, and in this age group the mortality rate is very low.…”

Does Anesthesia Contribute to Operative Mortality?

“…Anesthetic technique: five major categories were used including (a) the inhalation group, where a volatile anesthetic gas such as halothane or enflurane was used as the mainstay of anesthesia; (6) the inhalation plus narcotic group, which used a volatile gas with a small dose of narcotic agent (eg, morphine, fentanyl); (c) the narcotic only group, which used a narcotic agent to maintain anesthesia; (d) the narcotic plus inhalation group, which had the narcotic drug predomi¬ nating with only small amounts of volatile gases to "balance" the anesthesia; and (e) the spinal anesthesia group. Virtually all of the cases in the first four categories also received nitrous oxide.…”

Upper abdominal cancer surgery in the very elderly

“…While operating on the very elderly for cardiac, orthopedic, or vascular diseases is increasingly accepted, there is continued reluctance to recommend aggressive intervention for abdominal malignancies other than those arising in the colon [ 1-51. Although cancer is the leading cause of death after heart disease in the geriatric population, the morbidity and generally disappointing survival associated with operations for gastric, pancreatic, esophageal, or hepatobiliary primaries contribute to this attitude [6,7]. Unfortunately, the median survival of those offered palliative or non-operative options is 6-12 months whereas life expectancy at age 80 is at least 6 years for males and 7 years for females [8].…”