Surgical care and outcome for patients in their nineties

Burns-Cox, Nick; Wb, Campbell; Nmmen, B. A. J. van; Vercaeren, P. M. K.; Lucarotti, M. E.

doi:10.1002/bjs.1800840417

Cited by 25 publications

(8 citation statements)

References 9 publications

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“…In the study by Arenal and colleagues, the patients over-90 years with colorectal cancer who underwent urgent surgery accounted for 49% of the sample [16]. These data are similar to other reports [17, 18, 19, 20]. The possible explanation for this recurrent urgent presentation in nonagenarian patients is that the diagnosis was frequently triggered by a complication manifestation.…”

Section: Discussionsupporting

confidence: 74%

Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients

Novello

Mandarino

Saverio

et al. 2019

Heliyon

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Background The frailty of the very elderly patients who undergo surgery for colorectal cancer negatively influences postoperative mortality. This study aimed to identify risk factors for postoperative mortality in octogenarian and nonagenarian patients who underwent surgical treatment for colorectal cancer. Methods This is a single institution retrospective study. The primary outcomes were risk factors for postoperative mortality. The variables of the octogenarians and nonagenarians were compared by using t-test, chi-square test, and Fisher exact test. A multivariate logistic regression analysis was carried out on the combined cohorts. Results we identified 319 octogenarians and 43 nonagenarians (N = 362) who underwent surgery for colorectal cancer at the Sant’Orsola-Malpighi university hospital in Bologna between 2011 and 2015. The 30-day post-operative mortality was 6% (N = 18) among octogenarians and 21% (N = 9) for the nonagenarians. The groups significantly differed in the type of surgery (elective vs. urgent surgery, p < 0.0001), ASA score (p = 0.0003) and rates of 30-day postoperative mortality (6% vs. 21%, p = 0.0003). In the multivariate analysis ASA > III (OR 2.37, 95% CI [1.43–3.93], p < 0,001), and urgent surgery (OR 2.17, 95% CI [1.17–4.04], p = 0.014) were associated to post-operative mortality. On the contrary, pre-operative albumin≥3.4 g/dL (OR 0.14, 95% CI [0.05–0.52], p = 0.001) was associated with a protective effect on postoperative mortality. Conclusions In the very elderly affected by colorectal cancer, preoperative nutritional status and pre-existing comorbidities, rather than age itself, should be considered as selection criteria for surgery. Preoperative improvement of nutritional status and ASA risk assessment may be beneficial for stratification of patients and ultimately for optimizing outcomes.

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Section: Discussionsupporting

confidence: 74%

Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients

Novello

Mandarino

Saverio

et al. 2019

Heliyon

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“…The oldest patients with few comorbid conditions and nonemergency operations have outcomes comparable to younger age groups. 108 Studies [109][110][111] from the National Veterans Affairs Surgical Quality Improvement Program database have demonstrated that age, as an independent variable, is less important in predicting postoperative outcome than complexity scores, functional status, emergency nature of cases, or the preoperative anesthesia risk assessment scores. Still, the rate of surgical complications consistently increased with age, with 3 to 4 times as many of the oldest patients having more than one complication ( Table 4).…”

Section: Surgical and Perioperative Complicationsmentioning

confidence: 99%

Preventable Medical Injuries in Older Patients

Rothschild¹,

Bates²,

Leape³

2000

Arch Intern Med

253

151

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Injuries associated with hospitalization are more common in older (>/=65 years) than in younger patients (<65 years), and they may be more severe and more often preventable. The increasing age of the population magnifies the importance of this problem. In this review, we first consider medical injuries in general and then review the literature for 6 categories: adverse drug events, falls, nosocomial infections, pressure sores, delirium, and surgical and perioperative complications. For each of these categories, older patients appear to be at higher risk, ranging from a 2.2-fold increase for perioperative complications to a 10-fold increase for falling, based on Harvard Medical Practice Study rates. The main cause of these increased risks appears to be the diminished physiological reserve of elderly patients; however, age alone is a less important predictor of adverse events than comorbidities and functional status. Furthermore, many of these complications appear to be preventable, although the proportion preventable varies by type of complication. While some prevention strategies are specifically beneficial in older patients, many apply to all age groups. Geriatric care units and consultation systems have improved outcomes in some instances, although the data are mixed. The success of intervention varies by type of complications. For medications, various interventions have been successful, and fall prevention programs have been demonstrated to be effective in the nursing home and home.

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“…Cancer is common in nonagenarians. From surgical and oncological points of view this age group is not well understood, there being few reports concerning the impact of surgery in nonagenarians [1–12]. Cancer in these elderly patients presents an ethical dilemma for surgeons and oncologists as to how aggressive an approach should be taken when it comes to treating cancer, balancing the increased risks associated with surgery against the patient’s relatively short life expectancy.…”

Section: Introductionmentioning

confidence: 99%