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Characteristics, comorbidity burden and outcomes in centenarians undergoing surgery in a university hospital: A case
Jayden MacDowall1, Patrick Tully1, Ranj Guha1
1Department of Anaesthesia, Austin Health, Melbourne, Australia.
Insights
Surgery in centenarians is feasible despite high comorbidity and emergency presentation. Multidisciplinary care can lead to acceptable outcomes, showing age alone should not prevent surgical intervention for these elderly patients.
Area of Science:
- Geriatric Surgery
- Perioperative Medicine
- Surgical Outcomes Research
Background:
- The aging global population increases the number of centenarians requiring surgical intervention.
- Centenarians often present with significant comorbidities and frailty, posing unique challenges.
- Limited literature exists on the surgical management and outcomes for patients over 100 years old.
Purpose of the Study:
- To describe the demographics of centenarians undergoing surgery.
- To analyze intraoperative anesthesia management and postoperative outcomes.
- To identify factors influencing outcomes in this unique patient group.
Main Methods:
- Retrospective cohort study design.
- Analysis of 25 centenarian patients' perioperative and intraoperative data.
- Focus on demographics, procedure types, anesthesia management, and complications.
Main Results:
- The cohort was predominantly female (88%) with a median age of 101 years.
- Emergency surgeries comprised 72% of cases, with 60% undergoing intermediate-risk procedures.
- Intraoperative hypotension occurred in 64% of patients, and 68% experienced postoperative complications, with 20% having severe complications (Clavien-Dindo ≥ III).
Conclusions:
- Centenarian surgical patients frequently have comorbidities and present emergently.
- High-severity postoperative complications were independent of procedural risk.
- Surgical intervention in centenarians can yield acceptable outcomes with expert multidisciplinary care.
Introduction:
As the population ages, so too does the age of those requiring surgery. People over the age of 100, centenarians, often have a greater degree of comorbidity and frailty than their younger counterparts but may also have a greater incidence of events requiring surgical intervention. There is, however, a dearth of literature describing the clinical course and practical considerations for this vulnerable population undergoing surgery. We aimed to describe the demographics of centenarians undergoing surgery, the procedures they receive, their intraoperative anaesthesia management, and their postoperative outcomes.
Presentation Of Cases:
A retrospective cohort study was completed to understand key perioperative and intraoperative variables linked to improved outcomes. Of the 25 patients included in this study, 22 (88%) were female and the median age was 101 years. Emergency cases predominated (72%) and 44% of surgeries occurred after hours. 60% underwent an intermediate risk surgery, and no centenarians underwent high risk surgery in this study period.
Discussion:
64% of patients experienced at least one episode of intraoperative hypotension, with a median 3.5 epochs per patient. 68% of patients experienced postoperative complications and 20% of patients had a complication of Clavien-Dindo severity ≥ III. In centenarians, the risk of high severity postoperative complications was independent of the intrinsic procedural risk.
Conclusion:
Centenarian patients have an elevated burden of comorbidity, presenting often in the emergent setting. However, age alone should not preclude surgical intervention as expert multidisciplinary care can have acceptable outcomes.
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