Factors affecting surgical outcome in the elderly at Auckland Hospital

BACKGROUND: The aim of the present study was to define the factors which affect the outcome of major abdominal surgery in elderly patients. METHOD: Data were collected prospectively using the surgical audit on all patients who were 65-years-old or older and had undergone major abdominal surgery at Auckland Hospital between January 1997 and November 2000. Risk factors studied were age, sex, American Society of Anesthesiologists grade, operative duration, timing of surgery (elective, urgent or emergency), surgeon (consultant or registrar) and the presence of the scrubbed consultant in theatre. Surgical outcome (no complications, complications or death) was defined according to the complication stratification and severity score developed by the University of Otago. Direct logistic regression was used to determine the significance of the risk factors. RESULTS: 1141 patients (614 women and 527 men) who underwent 1248 procedures were studied. The factors that affected the mortality were the ASA grade (P = 0.0001) and operative timing (P = 0.0008). The factors that affected the severity of postoperative complications were ASA (P = 0.0001), operative timing (P = 0.0001) and duration (P = 0.0001). CONCLUSIONS: The ASA, timing and duration of surgery were the most significant factors affecting patient outcome. Age had a less important effect. Arranged surgery and short operative duration have a favourable outcome in selected elderly patients. Therefore, the elderly should not be denied indicated major abdominal surgery on basis of age alone.