Surgical care and outcome for patients in their nineties

Surgical care of the elderly poses special problems. Very little has been published on the management of patients aged 90 years and over.

This study reviewed a consecutive series of patients aged 90 years and over, admitted to hospital over 2 years under five general surgeons and two urologists. There were 129 patients (68 per cent women) aged 90-104 (median 92) years and a total of 141 admissions, 45 elective and 96 emergency. Gastrointestinal conditions were commonest (40 per cent of admissions), followed by undiagnosed abdominal pain (16 per cent), hernia (16 per cent), arterial disease (13 per cent) and urological problems (7 per cent).

Operation was required after 66 per cent of admissions (37 of 45 elective admissions and 56 (58 per cent) of 96 emergencies). In contrast to other studies of the very elderly, some patients were American Society of Anesthesiologists (ASA) grade 1, none of whom died after operation; no patient with ASA grade 5 was submitted to operation. Fifteen patients (12 per cent) died in hospital, three of 31 and seven of 50 respectively after elective and emergency surgery.

Very elderly patients can be managed with a reasonable expectation of good outcome after admission for surgical care.