Simoncelli, T.F.W. (2019) Perioperative and long-term outcomes in patients eighty years of age and older. thesis, Medicine.
Full text available on request.Abstract
Introduction: Life expectancy has increased in the last decades leading to the elderly being the fastest growing group in the population. This will also cause a higher percentage of elderly patients potentially still eligible for surgery. Higher age is associated with more comorbidities and higher mortality which calls for different perioperative care than for the nonelderly. There is limited information about patients of 80 years and older and their surgical outcomes. Therefore, the primary objective of this study is to map the characteristics, outcomes and determinants of a large cohort of patients of 80-years and older undergoing noncardiac surgery. Methods: Perioperative data of 8251 consecutive patients undergoing 19027 surgical interventions from 2004 until 2017 were retrospectively collected. Inclusion criteria were patients of 80 years or older, undergoing elective or urgent surgery. Patients who were outpatients or short stay patients, who underwent cardiac surgery or an anesthetic procedure, were excluded. The anesthesia procedure-codes included: pain management, placement of an intra-arterial or intravenous catheter, reanimation, life support, anesthesia or sedation outside the operation complex, intubation, and extubation. Each intervention was classified into a low-, intermediate- or highrisk surgical category. American Society of Anesthesiologists (ASA) classification, laboratory measurements, anesthetic and direct postoperative ward were also collected. Primary outcomes were length of hospital stay (LOS), destination after hospital discharge and 30-day and long-term postoperative mortality. Results: The analyses were performed on 7032 primary procedures. Over time the amount of total procedures remained rather constant. Of these procedures, 44.6% fell into the low-risk category, 47.9% into the intermediate-risk category and 7.5% were high-risk category procedures. During the study period the median LOS increased significantly for each higher risk-group. In the lowrisk group the LOS was 3 days, in the intermediate group 6 days and in the high-risk group 10 days. Over time the median LOS decreased from 5.8 days (IQR 1.9-14.5) in 2004-2007 to 4.6 days (IQR 1.9-9.0) in 2016-2017. In all surgical risk categories most of the patients went home after hospital discharge. The overall postoperative 30-day mortality of 469 patients (6.7%) was stable during the study period. Long-term survival is comparable for intermediate-risk and highrisk surgery (P=0.43). The 5-year estimate for the low-risk group is 0.49 ± 0.013, for the intermediate-risk group 0.38 ± 0.013 and 0.35 ± 0.029 for the high-risk group. Conclusion: The growing number of elderly in hospital was not reflected in our study, with a constant number of patients over the years. Thirty-day mortality remained constant with an average of 6.7%. Surgical risk and ASA classification were independent predictors for 30-day mortality. Long term mortality was comparable between intermediate- and high-risk surgery. The overall length of hospital stay decreased during the study period, with an average of 5.1 days and was associated with age, gender, surgical risk and ASA class. Three quarters of the patients went home after hospital discharge, with the highest percentage in the low-risk category and the lowest percentage in the intermediate-risk group. The majority of the patients have good outcomes, and with optimal preoperative care the outcomes can be further improved. Therefore, advanced age alone should not be the reason for exclusion from surgery.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Tolsma, dr. M. |
| Supervisor name: | Second supervisor: and Hoeks, dr. S.E. and Department: and Anesthesiology and Erasmus University Medical Center Rotterdam |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:43 |
| Last Modified: | 25 Jun 2020 10:43 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/504 |
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