Prediction of outcome of surgery and anesthesia in patients over 80

We studied the outcome of surgery in 500 patients over 80 years of age. Hospital mortality within one month of surgery was 6.2%. The American Society of Anesthesiologists class 1 to 5 preoperative evaluation scale was useful in predicting death—less than 1% of class 2 patients died, 4% of class 3, and 25% of class 4. Six of seven perioperative deaths were caused by mesenteric infarction. Myocardial infarction was the leading cause of postoperative death. Twenty-four percent of 141 patients who underwent upper abdominal surgery required controlled endotracheal ventilation for more than 24 hours postoperatively; 57% after intrathoracic surgery; and only 2% after surgery that did not enter pleura or peritoneum. Forty-seven patients underwent gallbladder surgery, and 27 peripheral underwent vascular surgery without any hospital fatality. Enflurane appears to be a safe general anesthetic for sick, elderly patients. (JAMA242:2301-2306, 1979)