Post-operative outcomes in older patients: a single-centre observational study

Area of Science:

• Geriatric Surgery
• Surgical Outcomes Research
• Patient Safety

Background:

• Aging populations worldwide necessitate increased surgical procedures for older adults.
• Older surgical patients face elevated risks of postoperative complications.
• Limited Australian data exists on age-related surgical outcomes, particularly concerning rapid response calls (RRCs).

Purpose of the Study:

• To compare postoperative outcomes between older (≥80 years) and younger surgical patients.
• To investigate the incidence of 30-day in-hospital mortality, unplanned intensive care unit (ICU) admission, and RRC activation within 72 hours postoperatively.
• To assess the association between increasing age and adverse postoperative events.

Main Methods:

• A 12-month retrospective observational study at a metropolitan Australian hospital.
• Inclusion of adult patients (≥16 years) undergoing surgery, excluding cardiac and obstetric/gynecological procedures.
• Quantification of patient comorbidities using the Charlson Comorbidity Index (CCI) and ASA physical status classification.

Main Results:

• Older patients (14.5%) experienced significantly higher 30-day mortality (2.3% vs. 0.2%), increased RRC rates (7.3% vs. 1.2%), and higher unplanned ICU admissions (3.2% vs. 1.6%) compared to younger patients (P < 0.001).
• Increasing age was independently associated with higher risks of RRC, unplanned ICU admission, and mortality (P < 0.01), even after adjusting for surgical type and CCI.
• General surgical procedures were most common (24.2%), with 65% of procedures being elective.

Conclusions:

• Older surgical patients face significantly increased risks of adverse postoperative outcomes, including RRCs, unplanned ICU admissions, and mortality.
• Emergency procedures further elevate these risks in older patients.
• Postoperative RRC incidence serves as a crucial indicator for assessing the quality of postoperative care and necessitates improved preoperative risk stratification and management strategies for the elderly surgical population.