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Surgery in nonagenarians: morbidity, mortality, and functional outcome
R J Ackermann1, R L Vogel, L A Johnson
1Department of Family and Community Medicine, Mercer University School of Medicine, Macon, GA.
The Journal of Family Practice
|February 1, 1995
Summary
Major surgery for nonagenarians (patients aged 90+) has a 20% perioperative mortality rate. Most patients maintain functional status, but survival is poor long-term, especially for those from nursing homes.
Area of Science:
- Geriatric Surgery
- Surgical Outcomes
- Elderly Patient Care
Background:
- Limited data exists on major surgery outcomes in the very elderly.
- Nonagenarians represent a unique and frail surgical population.
Purpose of the Study:
- To document outcomes of major surgery in patients aged 90 years or older.
- To identify predictors of mortality in this cohort.
Main Methods:
- A 7-year case series follow-up of 116 consecutive nonagenarian patients undergoing major surgery.
- Analysis of functional status, short- and long-term mortality, and survival predictors.
Main Results:
- 116 nonagenarians underwent 134 major operations; 19 died perioperatively, 23 within 30 days.
- Seven-year follow-up showed all but three patients had died.
- Worse survival was linked to nursing home admission, pre-surgery non-ambulatory status, and severe functional impairment.
Conclusions:
- Major surgery in nonagenarians carries a significant 20% perioperative mortality risk.
- Most patients retain functional status, but long-term survival is limited.
- The decision for major surgery in this frail population requires careful consideration.