The impact of demographic trends on hospital surgical care

The projected increase in numbers and percentages of elderly people has great potential impact on health services generally. Only rarely, however, has the impact of age of patients on a surgical service been quantitated. Two hundred fifty-five consecutive laparotomies performed in men older than 65 years of age were compared with 174 consecutive laparotomies in men younger than 65 years of age, all from a Veterans Administration Medical Center experience. Morbid factors, including mortality, increased with age with the greatest increments over the age of 75 years and especially over the age of 85 years. An intensity-of-care index was devised; the intensity-of-care ratios progressively increased with age. Unless there are significant technical advances, future surgical results will not be as good as they are at present, since the patient composition will be less favorable. Any estimates of the costs of surgical care in the future must include the projected age of patients as a major factor.