Surgery in patients aged ≥ 80 years: mortality and recovery in a nationwide cohort study*

INTRODUCTION: As the global population ages, the demand for surgical interventions in older adults is rising. Older patients face increased risks due to age-related physiological changes and comorbidities, making surgery and postoperative care challenging. This study aimed to assess short- and long-term mortality, as well as patient-centred outcomes such as days alive and at home 30 and 90 days after surgery, in patients aged ≥ 80 y undergoing surgical procedures. METHODS: This nationwide cohort study utilised data from the Swedish Perioperative Register, including surgeries in patients aged ≥ 80 y in Sweden from January 2019 to March 2023. We linked peri-operative data with the National Patient Register for comorbidities and with the National Cause of Death Register. The primary outcome was all-cause 30-day mortality, with secondary outcomes of 365-day mortality and days alive and at home 30 and 90 days after surgery. RESULTS: A total of 118,359 patients were included, with 54,320 undergoing elective and 64,039 acute surgeries. Thirty-day mortality was 1.2% for elective and 9.9% for acute surgeries. Mortality increased significantly with age, particularly for patients aged ≥ 90 y compared with those aged 80-84 y. Days alive and at home 30 and 90 days after surgery were significantly lower for acute surgery patients, indicating longer recovery times and more postoperative complications. DISCUSSION: Older adults, especially those aged ≥ 90 y, experience high mortality and significant challenges in postoperative recovery after acute surgeries. Elective surgeries are associated with lower short-term mortality, suggesting that age alone should not preclude surgical interventions. Tailored peri-operative care and patient-centred decision-making are essential to improve outcomes in this vulnerable population.