Surgery in a geriatric population

A prospective audit of 1111 general surgical procedures undertaken on 1040 elderly patients (over 64 years) revealed a mortality of 3.5% in potentially viable patients. Aged patients (over 74 years) had twice the mortality of old patients (65-74 years). Emergency surgery carried a sevenfold risk factor which is greater than is usually described. Of those patients who died (n = 56) 20 had a laparotomy for surgically incurable disease. Although the four grades of surgeon achieved similar mortality rates (range 4-5.8%), senior surgeons performed more major procedures (Consultants, 40%; SHOs, 19%). There was a low supervision rate of SHOs (37/100 overall, and 9/19 major cases). Of the 26 patients dying from medical disorders 17 had a previous history of that disorder, and only nine of these patients were admitted to our high dependency care unit. We conclude that mortality rates in the elderly could be improved by encouraging elective surgery and avoiding diagnostic laparatomy in patients with incurable surgical disease. We also suggest that no inexperienced surgeon should operate unsupervised on any elderly patient who is in ASA category 4 or 5, or who undergoes major or intermediate surgery. Further, all elderly patients in ASA category 4 or 5, or those with previous medical problems who have major emergency procedures should be managed postoperatively in a high dependency care unit.