The surgical patient of yesterday, today, and tomorrow—a time-trend analysis based on a cohort of 8.7 million surgical patients

Abstract

Background: Global healthcare delivery is challenged by the aging population and the increase in obesity and type 2 diabetes. The extent to which such trends affect the cohort of patients the authors surgically operate on remains to be elucidated. Comprising of 8.7 million surgical patients, the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database can be analyzed to investigate the echo of general population dynamics and forecast future trends. Material and methods: The authors reviewed the ACS-NSQIP database (2008–2020) in its entirety, extracting patient age, BMI, and diabetes prevalence. Based on these data, the authors forecasted future trends up to 2030 using a drift model. Results: During the review period, median age increased by 3 years, and median BMI by 0.9 kg/m2. The proportion of patients with overweight, obesity class I, and class II rates increased. The prevalence of diabetes rose between 2008 (14.9%) and 2020 (15.3%). The authors forecast the median age in 2030 to reach 61.5 years and median BMI to climb to 29.8 kg/m2. Concerningly, in 2030, eight of ten surgical patients are projected to have a BMI above normal. Diabetes prevalence is projected to rise to 15.6% over the next decade. Conclusion: General population trends echo in the field of surgery, with the surgical cohort aging at an alarmingly rapid rate and increasingly suffering from obesity and diabetes. These trends show no sign of abating without dedicated efforts and call for urgent measures and fundamental re-structuring for improved future surgical care.

Increasing perioperative age and comorbidity: a 16-year cohort study at two University hospital sites in Sweden

“…Our findings suggest that more vulnerable perioperative patients flow through our (tertiary) hospitals, which is in line with previous investigations 10 – 13 , 24 , 26 . Adding to this—perhaps expected finding—is the fact that when adjusting for age, acuity and illness severity, improved outcomes are seen over the study period.…”

“…A UK study has reported that high-risk patients accounted for 12.5% of surgical procedures but for 80% of postoperative deaths 6 . Knoedler and colleagues reported recently that the median age of the American surgical cohort increased by 3 years 2008–2020, and forecasted it to continuously rise until 2030, with the surgical cohort aging at a faster rate than the global population 24 . A national Swedish study found an annual increase in surgical incidence 2006–2013, with incidence rates peaking in the elderly 25 .…”

The combined risk predictive power of frailty and hypoalbuminemia in free tissue flap reconstruction: A cohort study of 34,571 patients from the NSQIP database

“…In a recent forecasting analysis involving more than 8 million surgical patients, our group showed that the surgical population is continuously aging. We projected that this aging trend will continue over the next decade, with the median patient age expected to reach 61.5 years by 2030, marking a 5.5‐year increase from 2020 (Knoedler et al, 2023). These findings may directly impact clinical care since aging and frailty are interwoven with multiple studies highlighting age and frailty as surgical risk factors (Aquina et al, 2017; Chung et al, 2021; Cooper et al, 2016; Maloney et al, 2020; Matsuo et al, 2018; Østergaard et al, 2020; Panayi et al, 2021; Panayi et al, 2022).…”

Interactions between oxidative stress and senescence in cancer: Mechanisms, therapeutic implications, and future perspectives

“…Currently, cancer related incidence and mortality is increasing as the global population ages [ 1 , 2 ]. Furthermore, older cancer patients usually have different treatment plan compared to normal cancer patients [ 3 , 4 ]. For instance, patients (≥80 years) with muscle-invasive bladder cancer were recommend to receive bladder-preservation therapy rather than standard radical cystectomy [ 5 ].…”