Populations around the world are rapidly aging. According to the WHO, the proportion of people over 60 years of age is increasing faster than any other population in nearly every country and is expected to surpass 2 billion people worldwide by the year 2050 . The term ‘elderly’ is a very subjective term. The term is based on the interpretation of the culture in which the person lives. Conventionally, “elderly” has been defined as a chronological age of 65 years old or older. Further, those who are 65 through 74 years old are referred to as “early elderly” and those over 75 years old are known as “late elderly.” The evidence upon which this definition is based is unknown, however. In this current study, we compared the short-term colorectal surgical treatment outcomes in three consecutive elderly age groups.
Even in developing countries, most older people die of non-communicable diseases such as heart disease, cancer and diabetes, rather than from infectious and parasitic diseases. Additionally, older people often have several coexisting health problems, such as diabetes and heart disease. Elderly patients represent a high percentage of patients diagnosed and treated for colon surgery due to their progressive increase in life expectancy with the consequent aging population . Health status is an important factor that has a significant impact on the quality of life and mortality on the elderly population after surgery. Although the preoperative statuses, as evaluated by the ASA scoring system, were worse in group 3 than in groups 1 and 2, almost all of the patients could be treated with surgery in this study. A study from the USA reported that arthritis was the most prevalent (48.9%) chronic condition among elderly patients ≥ 65 years, followed by hypertension (40.3%) . In the present study, cardiovascular disease was the most common disease (77-79%) among the observed elderly patients followed by DM (30–37.5%). However, there were no cardiovascular disease differences between the groups; however, more DM, respiratory disease and cerebrovascular disease diagnoses were made for group 3 compared with group 1 and 2.
The most frequent symptoms that patients present to hospitals are usually different for various age groups. Mahdi et al. reported that the most frequent symptoms were per-anal bleeding (35%), weakness (25%), constipation (18%), a recent change in bowel habits (14.2%) and paradoxical diarrhea (9%) for patients with colorectal malignancies . Additionally, only abdominal pain was more frequent in patients under 75 years of age. Parallel to this literature, the cause of hospital admission was different in all three groups. The most common cause of admission to the hospital was blood in the stool in the younger than 70-year-old patient, bowel obstruction in the patients between 70–80 and anemia in the patients that were greater than 80 years of age. This difference might be due to the heterogeneity of our study group (which contained both malignant and non-malignant colon surgeries). Moreover, colorectal cancers in older patients are more likely revealed by a complication, this fact is related to a delay in the diagnosis in older patients and this is due to negligence of symptoms in these patients .
Knowledge regarding the colorectal surgical management in older patient’s is rapidly expanding. Several studies have shown that age alone does not influence outcomes after surgery for colorectal diseases, but it is rather the comorbidity and compromised physical capacity to recover from adverse events that may occur in connection with major surgery . Schwander et al. divided patients into the following age-related groups: patients 50 years of age or younger, patients ranging from 51 to 70 years of age, and patients older than 70 years of age . They observed no statistically significant major and minor complication differences among the three groups. Nevertheless, controversy continues because other authors have reported a somewhat higher complication rate in elderly patients [12–15]. Additionally, they observed that postoperative hospitalizations were significantly prolonged in patients older than 70 years. In our study, there was only a significant intraoperative complication difference between groups 1 and 3. We think that this difference was dependent upon surgical technique difficulties and not age-related complications. Despite the fact that no statistically significant difference was found between the three age groups, patients aged more than 80 years presented greater postoperative complications. It is also of note that postoperative complications related to surgery developed in only 12 patients from the group 3 elderly patient cohort (21.4%). The non-surgical complication incidence increased significantly with age. In the elderly patient group (≥80 years) we have objectified a higher percentage of non-surgical post-operative complications, mostly due to a higher number of cardiovascular disease occurrences, as well as general postoperative complications caused by pneumonia. As a result, the systemic complications were more frequent in group 3 than in groups 1 and 2. Furthermore, there were no systemic complication significant differences between group 1 and 2. Hence, the term “elderly”, which is defined as older than 65 years of age, may be mentioned as a threshold of older than 80 years of age in colon surgery instances.
As previously reported, the hospital length of stay for elderly colorectal surgery patients was the same as that in younger patients [2, 16, 17]. Senagore et al. reported there was no difference between patients 70 years old or older who underwent colorectal surgery compared with patients younger than 60 years of age . In the current study, the group 3 patients (those older than 80 years) had longer hospital stay durations than the other groups. This was the result of excess of comorbidities in the patients older than 80 years of age.
The present study was subject to several limitations. First, it was not a randomized controlled study; therefore, a prospective randomized controlled study is needed to demonstrate that colon surgery in elderly patients is truly a feasible procedure for different older age groups. Additionally, the indication of colon surgery was not distinguished between malignant and non-malignant diseases in this study.