Elders May Have Higher Risk of Complications, Death After Abdominal Surgery

The risk of complications and early death after commonly performed abdominal surgical procedures appears to be higher among older adults, according to a report in the Archives of Surgery.

It is estimated that one in six Americans will be aged 65 or older by 2020 and that 15% of this population will be older than the age of 85, according to the article. "Approximately 2 million older Americans undergo abdominal surgical operations each year," the authors noted. "For clinicians, patients, and families considering abdominal surgical procedures, informed decision making is challenging because of limited data regarding the risks of adverse perioperative events associated with advancing age."

Nader N. Massarweh, MD, and colleagues at University of Washington School of Medicine in Seattle, examined complication and death rates of 101,318 adults aged 65 or older who underwent common abdominal procedures such as cholecystectomy, hysterectomy, and colectomy from 1987 to 2004. Complications were recorded within 90 days of discharge and deaths were recorded within 90 days of hospital admission.

The 90-day complication rate was 17.3% and the 90-day death rate was 5.4%. "Advancing age was associated with increasing frequency of complications (aged 65 to 69, 14.6%; aged 70 to 74, 16.1%; aged 75 to 79, 18.8%; aged 80 to 84, 19.9%; aged 85 to 89, 22.6%; and aged 90 or older, 22.7%) and mortality (aged 65 to 69, 2.5%; aged 70 to 74, 3.8%; aged 75 to 79, 6%; aged 80 to 84, 8.1%; aged 85 to 89, 12.6%; and aged 90 or older, 16.7%)," the authors noted. "After adjusting for demographic, patient, and surgical characteristics as well as hospital volume, the odds of early postoperative death increased considerably with each advance in age category. These associations were found among patients with both cancer and noncancer diagnoses and for both elective and nonelective admissions."

"Older adults may be less able to adapt to the stress of surgery or to the added stress of any postoperative complication, greatly increasing their risk of early mortality," the authors concluded. "These effects appear to be additive, highlighting the need for interventions to both prevent decline among older patients and avoid postsurgical complications."

— Source: Archives of Surgery