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Thoracotomy in the octogenarian.

K S Naunheim1, K A Kesler, S A D'Orazio

  • 1Department of Surgery, St. Louis University Medical Center, Missouri 63110-0250.

The Annals of Thoracic Surgery
|April 1, 1991
PubMed
Summary
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Thoracotomy is feasible in octogenarians, with elective procedures showing significantly lower mortality (13%) compared to emergent cases (80%). Patient age and comorbidities did not predict operative death in this elderly cohort.

Area of Science:

  • Cardiothoracic Surgery
  • Geriatric Surgery
  • Thoracic Oncology

Background:

  • Octogenarians are infrequently referred for thoracic operations due to concerns about morbidity and limited life expectancy.
  • Previous assumptions suggested high risks associated with thoracotomy in patients aged 80 and older.

Purpose of the Study:

  • To evaluate the safety and outcomes of thoracotomy in octogenarian patients.
  • To determine if perceived risks of morbidity and mortality are valid in this age group.

Main Methods:

  • Retrospective review of 50 patients aged 80 years or older undergoing thoracotomy between 1980 and 1990.
  • Analysis of operative procedures, diagnoses (cancer vs. benign disease), complications, and mortality rates.
  • Actuarial survival analysis for elective cases.

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Main Results:

  • Operative mortality was 80% for emergent cases versus 13% for elective cases (p < 0.01).
  • Major complications occurred in 38% of patients.
  • No significant relationship was found between operative death and patient age, sex, operation type, malignancy, or comorbidities (cardiac disease, COPD).
  • Actuarial survival at 1 and 2 years for elective patients was 56% and 44%, respectively.

Conclusions:

  • Thoracotomy can be safely performed in octogenarians, particularly for elective indications.
  • Concerns regarding high morbidity and mortality in this age group may be overstated, as patient age and comorbidities did not predict outcomes.
  • Elective thoracotomy offers a reasonable survival benefit for selected octogenarian patients.