Surgery in patients aged ≥ 80 years: mortality and recovery in a nationwide cohort study

As the global population ages, the demand for surgical interventions in older adults is rising. Older patients face increased risks due to age-related physiological changes and comorbidities, making surgery and postoperative care challenging. This study aimed to assess short- and long-term mortality, as well as patient-centred outcomes such as days alive and at home 30 and 90 days after surgery, in patients aged ≥ 80 y undergoing surgical procedures.

This nationwide cohort study utilised data from the Swedish Perioperative Register, including surgeries in patients aged ≥ 80 y in Sweden from January 2019 to March 2023. We linked peri-operative data with the National Patient Register for comorbidities and with the National Cause of Death Register. The primary outcome was all-cause 30-day mortality, with secondary outcomes of 365-day mortality and days alive and at home 30 and 90 days after surgery.

A total of 118,359 patients were included, with 54,320 undergoing elective and 64,039 acute surgeries. Thirty-day mortality was 1.2% for elective and 9.9% for acute surgeries. Mortality increased significantly with age, particularly for patients aged ≥ 90 y compared with those aged 80-84 y. Days alive and at home 30 and 90 days after surgery were significantly lower for acute surgery patients, indicating longer recovery times and more postoperative complications.

Older adults, especially those aged ≥ 90 y, experience high mortality and significant challenges in postoperative recovery after acute surgeries. Elective surgeries are associated with lower short-term mortality, suggesting that age alone should not preclude surgical interventions. Tailored peri-operative care and patient-centred decision-making are essential to improve outcomes in this vulnerable population.