[The prognosis of surgery on the elderly. Proposal for a parametric evaluation]

To data there are no preoperative systems of evaluating surgical risk specifically in geriatric patients. Given that it was thought useful to formulate a score-based prognostic system for these patients based on surgical risk, the authors collected a wide range of preoperative data with the aim of identifying the easily determined variables.

While data from other hospital centres are in the process of being collected, the authors report the data for 122 over 65-year-old patients who underwent elective surgery up until 30-1-1996 out of a total of 329 hospitalized patients. In addition to a wide series of objective, laboratory and instrumental data, the study also took into account the pathology requiring to surgery, any associated morbid conditions, psychic and social conditions, the type of surgery and local and/or general postoperative complications.

Hernia of the abdominal wall were found to be the most frequent cause of surgery (41 cases), followed by 27 neoplasias of various organs and biliary lithiasis (20 cases). Cardiovascular diseases were the most common associated pathologies (85 patients). A total of 13 major and 80 medium operations were performed, including 16 cholecystectomies. Among the general complications, an altered acid-base balance was found in 7 patients. Two deaths were recorded within 30 days of surgery. When the data collection is complete, the results will be analysed statistically in order to obtain a numerical calculation of the coefficients of risk correlated to the individual variables.

This will enable the criteria of operability to be broadened, thereby allowing surgery to be performed in those patients who are currently excluded merely on the basis of the personal judgement of the surgeon and anesthetist.