Abstract
The objective of this study was to compare elective with emergent surgery in patients over the age of 90 years. We retrospectively reviewed the records of patients over 90 years of age who underwent alimentary tract surgery between1994 and2002 at acommunity teaching hospital.Of100 patients(mean age 92 years; range 90 to 98 years), 82 were women and 18 were men. Seventy-three percent were admitted from private homes or assisted-living facilities, and 27% came from a skilled-nursing facility (SNF). Major comorbid conditions existed in 93%. Procedures included right hemicolectomy (22%), adhesiolysis and/or small bowel resection (19%), cholecystectomy (14%), left-sided or sigmoid colectomy (11%), and perineal proctectomy (8%). Overall morbidity and mortality were 36% and 15%, respectively. Postoperative complications included respiratory failure and pneumonia (11%), arrhythmias (9%), delirium (7%), congestive heart failure and myocardial infarction (6%), and urinary complications (4%). Twentyeight percent of the operations were elective, and 72% were emergent. Morbidity and mortality were higher in the emergent group (41% and 19%, respectively) than in the elective group (26% and 4%, respectively; P = 0.04), especially for patients with an emergent surgical problem who came from a nursing home (22%). Average length of stay was 12 ±10 days (range 2 to 69 days) with little difference between elective and emergent cases. Sixty-four percent of patients were discharged to skilled-nursing facilities. Alimentary tract surgery can be performed safely in nonagenarians, and they should not be denied surgical care solely because of age.
Similar content being viewed by others
References
Administration of Aging Report: A Profile of Older Americans, 2001. Department of Health and Human Services. Available at http://www.aoa.gov/aoa/stats/pro.le/default.htm.
Watts D, McCally M. Demographic perspectives. In Cassal DK, Walsh JR, eds. Geriatric Medicine. New York: Springer-Verlag, 1984, pp 3–15.
Watters JM. Surgery in the elderly. Can J Surg 2002;45:104–108.
Greenburg AG, Saik RP, Coyle JJ, Peskin GW. Mortality and gastrointestinal surgery in the aged: Elective versus emergency procedures. Arch Surg 1981;116:788–791.
Rigberg D, Cole M, Hiyama D, McFadden D. Surgery in the nineties. Am Surg 2000;66:813–816.
Violi V, Pietra N, Grattarola M, Sarli L, et al. Curative surgery for colorectal cancer: Long-term results and life expectancy in the elderly. Dis Colon Rectum 1998;41:291–298.
Kemeny MM, Busch-Devereaux E, Merriam LT, O’Hea BJ. Cancer surgery in the elderly. Hematol Oncol Clin North Am 2000;14:169–192.
Law WL, Chu KW, Tung PH. Laparoscopic colorectal resection: A safe option for elderly patients. J Am Coll Surg 2002; 195:768–773.
Spivak H, Maele DV, Friedman I, Nussbaum M. Colorectal surgery in octogenarians. J Am Coll Surg 1996;183:46–50.
Mulcahy HE, Patchett SE, Daly L, O’Donoghue DP. Prognosis of elderly patients with large bowel cancer. Br J Surg 1994;81:736–738.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article was written by Lt. Susan C. Clark, M.D., U.S.N. while a resident at Abington Memorial Hospital training in general surgery. The views expressed in this article are those of the author and do not refiect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.
Rights and permissions
About this article
Cite this article
Blansfield, J.A., Clark, S.C., Hofmann, M.T. et al. Alimentary tract surgery in the nonagenarian: Elective vs. emergent operations. J Gastrointest Surg 8, 539–542 (2004). https://doi.org/10.1016/j.gassur.2004.03.009
Issue Date:
DOI: https://doi.org/10.1016/j.gassur.2004.03.009