"Physiological" age as an outcome predictor for abdominal surgery in elderly patients

It would seem that a large discrepancy exists between the "chronological" age and "apparent" age of elderly patients, and we often observe that the latter reflects the results of surgical procedures very well. In the present study, we reviewed 258 patients aged 70 years or older who underwent elective abdominal operations under general anesthesia, to evaluate an outcome predictor representing their "physiological" age. A total of 24 preoperative variables were compared between patients who left the hospital in a satisfactory condition, being survivors, and those who died in hospital despite the operative procedure performed, being nonsurvivors. In the group of patients aged between 70 and 79 years, there was no significant difference between the survivor and nonsurvivor groups for any of the variables examined; however, in the group of patients aged over 80 years old, the oldest of whom was 93 years, there were significant differences in the total lymphocyte count (TLC) and the performance status (PS), as well as in age, between the survivor and nonsurvivor groups. Utilizing the three variables of age, PS, and TLC, a computer-generated discriminant function analysis yielded an equation which discriminated survival with 97% accuracy, and mortality with 83% accuracy. These findings indicate that the PS and TLC scores added to the chronological age should be considered when deciding whether a surgical procedure is appropriate for an elderly patient.