Surgical mortality in patients more than 80 years of age

Patients aged >80 years account for a considerable proportion of the population admitted to hospital under general surgeons. We aimed to establish the prevalence of mortality in patients aged >80 years who underwent emergency general, vascular and urological surgery within a 13-month period at a large teaching hospital in the UK.

A retrospective analysis was carried out of all patients aged ≥80 years admitted on acute on-call emergency under general, vascular or urological surgeons. Patient demographics (including comorbidities and sex) were recorded. American Society of Anesthesiologists scores were reviewed from anaesthetic records. The outcome measure was 30-day mortality for those who had undergone emergency general, vascular or urological surgery.

A total of 4,069 patients were admitted under general, vascular and urological surgeons during the study period. Of these patients, 521 were aged >80 years. Sixty-three patients underwent emergency surgery and 12 died <30 days after surgery (mortality = 19%). The most common procedure was laparotomy (20 cases). The most common co-morbidity was cardiac disease, which included hypertension, ischaemic heart disease, and hypercholesterolemia. A considerable proportion of patients also had malignant disease and arthritis.

The present study suggests that emergency surgery should not be denied to subjects aged >80 years based on age alone. Mortality varies according to the type of emergency procedure. Mortality was highest after laparotomy and vascular surgery whereas, for more routine procedures such as hernia repair and abscess drainage, survival was almost 100% after 30 days.