What is the clinical evidence from this study?

Study design: Cohort. Population: 30-day all-cause mortality in surgical patients (n=174). Intervention: General Surgery vs. Octogenarian patients. Primary outcome: 30-day all-cause mortality (RR 2.71, 95% CI 1.09-6.76, p=0.02).

What does this research mean for the field?

Nonagenarian patients have a 30-day all-cause mortality of 26.0%, nearly triple that of octogenarian patients at 9.6%, indicating significantly worse surgical outcomes in the older cohort. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

The study aims to compare surgical outcomes between nonagenarian and octogenarian patients to inform surgical decision-making.

February 8, 2026Canadian Journal of Surgery1 citationsOpen Access

Surgical outcomes in nonagenarian versus octogenarian patients: a propensity-matched analysis with implications for shared decision-making

FKFahim KananiTel Aviv University EKEduard KhabarovWolfson Medical Center ACAndrey ChopenWolfson Medical Center

Key Result

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.

Key Points

The study aims to compare surgical outcomes between nonagenarian and octogenarian patients to inform surgical decision-making.
Conducted a propensity-matched analysis
Compared surgical outcomes in nonagenarians and octogenarians
Assessed 30-day mortality and functional impairment rates
Nonagenarians experienced nearly triple the 30-day mortality compared to octogenarians
High rates of functional impairment were noted among surviving nonagenarians
Findings indicate potential selection bias in surgical nonagenarians, supporting a conservative approach

Study Design

Type

Cohort (n=174)

Multicenter

Structured PICO

Does general surgery in nonagenarian patients result in worse 30-day mortality compared to octogenarian patients?

Population

174 patients aged 80 to 99 years who underwent general surgery (cholecystectomy, appendectomy, right hemicolectomy, or inguinal hernia repair), including 73 nonagenarians and 101 octogenarians.

Intervention

General surgery in nonagenarian patients (aged 90-99 years)

Comparator

General surgery in octogenarian patients (aged 80-89 years), matched 1:1 using propensity scores

Outcome

30-day all-cause mortalityhard clinical

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.

Main Result

Effect estimate: RR 2.71 (95% CI 1.09-6.76)

Absolute Event Rate: 26% vs 9.6%

p-value: p=0.02

Limitations

Retrospective design may introduce bias.
Selection bias due to including only patients who underwent surgery.
Imbalance in frailty status between groups not fully adjusted for.

Abstract

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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