Key result
General surgery in nonagenarians linked to ~171% higher postoperative mortality versus octogenarians.
Why the study?
Does general surgery in nonagenarian patients result in worse 30-day mortality compared to octogenarian patients?
Cohort (n=174)
No
Does general surgery in nonagenarian patients result in worse 30-day mortality compared to octogenarian patients?
Effect estimate: RR 2.71 (95% CI 1.09-6.76)
Absolute Event Rate: 26% vs 9.6%
p-value: p=0.02
Nonagenarians face nearly triple the 30-day mortality and higher rates of functional impairment after general surgery compared to octogenarians, supporting nonoperative management as the default approach.
Higher mortality in nonagenarians warrants caution in surgical decisions; leaves open whether frailty-adjusted selection improves outcomes in prospective cohorts.
Nonagenarian patients face substantially worse surgical outcomes than octogenarian patients, with nearly triple the 30-day mortality and high rates of functional impairment among survivors. The persistent frailty imbalance despite matching suggests inherent selection bias in surgical nonagenarians. Unlike octogenarians, for whom selective surgery may be justified, these findings support careful consideration of nonoperative management as the default approach for nonagenarians, with surgery reserved for highly select cases after comprehensive geriatric assessment and thorough shared decision-making with the patient.
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Kanani et al. (2026) conducted a cohort in 30-day all-cause mortality in surgical patients (n=174). General Surgery vs. Octogenarian patients was evaluated on 30-day all-cause mortality (RR 2.71, 95% CI 1.09-6.76, p=0.02). Nonagenarian patients had a 30-day all-cause mortality of 26.0% compared to 9.6% in octogenarian patients, indicating a significantly higher risk of mortality in the older cohort.
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