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Surgery for the Very Old: Are Nonagenarians Different?
Tanner I Kim1, Anand Brahmandam1, Laura Skrip2
1From the *Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
The American Surgeon
|February 21, 2020
Summary
Nonagenarians, the very old, are increasingly undergoing surgery and face higher mortality and longer hospital stays than octogenarians. Further study is needed on their quality of life and healthcare costs.
Area of Science:
- Geriatric surgery
- Surgical outcomes research
- Demographic trends in healthcare
Background:
- Octogenarians and nonagenarians are often grouped as the "very old."
- The proportion of very old individuals in the population is increasing.
- Existing research often overlooks distinct differences between these age groups.
Purpose of the Study:
- To differentiate surgical trends, demographics, and outcomes between octogenarians and nonagenarians.
- To analyze age-specific differences in surgical patient populations.
- To inform healthcare strategies for an aging demographic.
Main Methods:
- Utilized the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2007-2012.
- Analyzed non-emergent vascular, orthopedic, and general surgery procedures.
- Compared demographic data, surgical types, and patient outcomes between octogenarians and nonagenarians.
Main Results:
- Nonagenarians showed a significant increase in surgical procedures (RR=1.42) across specialties, while octogenarian rates remained stable.
- Nonagenarians experienced higher 30-day perioperative mortality compared to octogenarians.
- Nonagenarians had a longer hospital stay post-surgery than octogenarians.
Conclusions:
- Nonagenarians represent a growing segment of surgical patients with poorer outcomes.
- This demographic exhibits significantly higher perioperative mortality and prolonged hospital stays.
- Further research on the impact of surgery on nonagenarians' quality of life is crucial to address rising healthcare costs.
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