General surgery in patients aged 80 years and older

Rørbæk‐Madsen, M.; Dupont, Gitte; Kristensen, Katrine Lawaetz; Holm, Torbjörn; Sørensen, Jesper Roed; Dahger, H.

doi:10.1002/bjs.1800791141

Cited by 40 publications

(27 citation statements)

References 6 publications

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“…It is well demonstrated that if postoperative 30-days mortality increases with the age, the presence and the number (two or more) of co-morbid disease is more important than chronological age as a risk factor; elderly patients without co-morbid conditions does not carry a substantial increased mortality risk [2][3][4]7,13].…”

Section: Discussionmentioning

confidence: 99%

“…As the elderly population grows, more than 50% of all hospitalized patients will be of geriatric age [1][2][3]. Because of it, rectal cancer shows a high incidence in older patients and radical surgical resection remains the most effective treatment; therefore, many studies on the shortand long-term outcome of surgery in the elderly have been performed.…”

Section: Introductionmentioning

confidence: 99%

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Rectal cancer surgery in the elderly: A multivariate analysis of outcome risk factors

Bufalari

Giustozzi

Burattini

et al. 2006

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rectal cancer surgery in the elderly: A multivariate analysis of outcome risk factors

Bufalari

Giustozzi

Burattini

et al. 2006

Journal of Surgical Oncology

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“…We found that postoperative complications and mortality in patients aged 80 years and older undergoing emergency surgery were 2.5 times higher than in those aged 65-79 years. Reports 12,13 indicate that mortality in the elderly undergoing emergency surgery is almost three times higher than in those undergoing elective surgery. Among operative factors, systemic abnormalities do not present typical symptoms as they do in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Emergency Abdominal Surgery in Patients Aged 80 Years and Older

et al. 2000

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The outcome of emergency abdominal surgery in elderly patients remains unsatisfactory. We studied factors contributing to the outcome of abdominal emergency surgery in elderly patients, particularly in those aged 80 years and older. Subjects were 61 patients aged 80 years and older (group A) and 108 patients aged from 65 to 79 years (group B) who underwent emergency abdominal surgery between 1983 and 1997. Complications were significantly higher in group A than in group B, with respiratory failure the most common postoperative complication. Mortality rate within 30 days after surgery was also higher in group A (9.8%) than in group B (3.3%). Complications and mortality did not differ significantly between those with and without preexisting concomitant disease in group A. Systemic inflammatory response syndrome (SIRS) was seen in 35 patients in group A and 50 in group B. Severe complications occurred in 62.5% of group A with preoperative SIRS. Mortality in those with SIRS was significantly higher than those without. SIRS is thus a feasible predictor of poor outcome in patients aged 80 years and older who have emergency abdominal surgery and in those aged from 65 to 79 years. Patients with SIRS should initially receive minimal treatment whenever possible, rather than be overtreated, until their conditions stabilize.

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“…In times of an ever ageing population, the numbers of patients with multiple medical co-morbidities presenting to the general surgical 'take' having suffered a catastrophic surgical event,are likely to increase. 1,2 Surgical intervention, with little hope of a cure, a return to independent living or an acceptable quality of life, may lead to unnecessary end-of-life suffering for the patients and their relatives, and consumes significant financial resources.…”

mentioning

confidence: 99%

Decisions to operate: the ASA grade 5 dilemma

Horwood

Ratnam

Maw

2011

annals

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INTRODUCTION Deciding to operate on high risk patients suffering catastrophic surgical emergencies can be problematic. Patients are frequently classed as American Society of Anesthesiologists (ASA) grade 5 and, as a result, aggressive but potentially lifesaving intervention is withheld. The aim of our study was to review the short-term outcomes in patients who were classed as ASA grade 5 but subsequently underwent surgery despite this and to compare the ASA scoring model to other predictors of surgical outcome. METHODS All patients undergoing emergency surgery with an ASA grade of 5 were identified. Patient demographics, indications for surgery, intraoperative findings and outcomes were recorded. In addition to the ASA scores, retrospective Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P POSSUM) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated and compared to the observed outcomes. RESULTS Nine patients (39%) survived to discharge. ASA grade was a poor predictor of outcome. P POSSUM and APACHE II scores correlated significantly with each other and with observed outcomes when predicting surgical mortality. The median stay for survivors in the intensive care unit was nine days. CONCLUSIONS In times of an ageing population, the number of patients suffering catastrophic surgical events will increase. Intervention, with little hope of a cure, a return to independent living or an acceptable quality of life, leads to unnecessary end-of-life suffering for patients and their relatives, and consumes sparse resources. The accuracy and reliability of ASA grade 5 as an outcome predictor has been questioned. P POSSUM and APACHE II scoring systems are significantly better predictors of outcome and should be used more frequently to aid surgical decision-making in high risk patients.

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General surgery in patients aged 80 years and older

Cited by 40 publications

References 6 publications

Rectal cancer surgery in the elderly: A multivariate analysis of outcome risk factors

Rectal cancer surgery in the elderly: A multivariate analysis of outcome risk factors

Emergency Abdominal Surgery in Patients Aged 80 Years and Older

Decisions to operate: the ASA grade 5 dilemma

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