Emergency and elective surgery in patients over age 70

Emergency surgery in 100 patients over age 70 was associated with a 31 per cent morbidity and a 20 per cent mortality, significantly greater than the 6.8 per cent morbidity and 1.9 per cent mortality following elective procedures in the same age group (P less than .0005). Sixteen per cent (100 of 613) of all geriatric patients were operated on under emergent conditions and the postoperative hospitalization was often significantly prolonged when compared with similar elective operations (P less than .05). Emergency surgery was most commonly performed on the large bowel (25%), abdominal wall (17%), stomach (17%), biliary tract (11%), and small bowel (10%). Inguinal herniorraphy was the most frequently performed elective procedure (33%), followed by colon resection (25%), and cholecystectomy (12%). Fifty-nine per cent (23 of 39) of complications associated with urgent operation and 39 per cent (16 of 41) following elective surgery involved the cardiorespiratory systems and were frequently related to underlying diseases. Of the 20 patients who died in the intensive care unit of multisystem failure, 16 had undergone emergency procedures. Elective surgery in the elderly may be performed safely; however, emergency surgery entails a high risk to the patient and a high cost in hospital resources.