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Background While some single center studies have demonstrated that major surgical operations are safe to perform in older adults, most multicenter database studies find advancing age to independently predict adverse postoperative outcomes. We hypothesized that thirty-day postoperative mortality, complications, failure to rescue rates and postoperative length of stay will increase with advancing age. Design Retrospective cohort study. Setting Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participants Patients undergoing non-emergent major general surgical operations between 2005 and 2008 were studied. Measures Postoperative outcomes of interest were complications occurring within 30 days of the index operation, return to OR within 30 days, failure to rescue after a postoperative complication, post-surgical length of stay and 30 day mortality. Results A total of 165,600 patients were studied. The rates of postoperative mortality, overall morbidity, and each type of postoperative complication increased as age increased. The rates of failure to rescue after each type of postoperative complication also increased with age. Mortality rates in patients ≥80 following renal insufficiency (43.3%), stroke (36.5%), myocardial infarction (35.6%), and pulmonary complications (25-39%) were particularly high. Median postoperative length of stay increased with age following surgical site infection, UTI, pneumonia, return to OR, and overall morbidity, but not after venous thromboembolism, stroke, myocardial infarction, renal insufficiency, failure to wean from the ventilator or reintubations. Conclusion Thirty-day mortality, complications and failure to rescue rates increase with advancing age following non-emergent general surgical operations. Patients over 80 years of age have especially high mortality following renal, cardiovascular, and pulmonary complications. As patient age advances, surgeons need to be more selective regarding who will benefit from the surgical intervention.

Objective(s) The purpose of this study was to evaluate the relationship of a history of falls (a geriatric syndrome) to postoperative outcomes in older adults undergoing major elective operations. Design Prospective, cohort study. Setting Referral medical center. Patients Persons 65 years and older undergoing elective colorectal and cardiac operations were enrolled. The predictor variable was having fallen in the six months prior to the operation. Interventions None. Main Outcome Measures Postoperative outcomes measured included thirty-day complications, need for discharge institutionalization and thirty-day readmission. Results There were 235 subjects with a mean age of 74±6 years. Pre-operative falls occurred in 33%. One or more postoperative complications occurred more frequently in the group with prior falls compared to the non-fallers following both colorectal (59% vs. 25%; p=0.004) and cardiac (39% vs. 15%; p=0.002) operations. These findings were independent of advancing chronologic age. Need for discharge to an institutional care facility occurred more frequently in the group that had fallen in comparison to the non-fallers in both the colorectal (52% vs. 6%; p<0.001) and cardiac (62% vs. 32%; p=0.001) groups. Similarly, 30-day readmission was higher in the group with prior falls following both colorectal (p=0.043) and cardiac (p=0.016) operations. Conclusions A history of one or more falls in the six months prior to an operation forecasts increased postoperative complications, need for discharge institutionalization and thirty-day readmission across surgical specialties. Utilizing a history of prior falls in preoperative risk assessment for an older adult represents a shift from current preoperative assessment strategies.