[Evaluation of the surgical risk and preparation to major surgical intervention in geriatric surgery]

The progress in surgery, anaesthesia, pre and postoperative care improves the number of old patients undergoing major surgery. The preoperative physiologic assessment is very important to identify patients who are at higher risk group and to plan the therapeutical strategics.

This study has been carried out on 849 patients aged 70 years and over who underwent major surgery; biliary tract surgery in 314 cases, colorectal in 279, gastroesophageal in 144, vascular in 48, jejunal in 32, pulmonary in 13, pancreatic in 11, hepatic in 8. 158 patients underwent urgency surgery. Mortality and morbidity index are related to the age of the patients, the urgency of the treatment, the time required for the operation, the preoperative physiologic assessment.

The overall mortality rate was 13.7%: 84 patients died for cardiovascular complications and 32 for pulmonary complications. Mortality rate was 6% after elective surgical treatment and 48% in urgency. The urgency influences considerably the mortality in the group over 80 years than in younger (p < 0.01). The difference in mortality after elective surgery was less significative (p < 0.06). The time required for the operation doesn't influence the mortality rate.

The authors emphasize that the preoperative physiologic assessment to identify patients at higher risk and an accurate preoperative care may reduce the mortality rate also in patients over 80 years undergoing major surgery. In urgency, when the patients cannot undergo a preoperative assessment and care, the postoperative mortality is higher in the group over 80 years than in younger.