Colorectal Surgery in the Elderly: An Audit of Surgery in Octogenarians

Abstract

Background: Morbidity and mortality rates are higher in elderly compared to younger patients undergoing colorectal cancer surgery. This study was undertaken to see whether this finding applied to all colorectal surgery in the elderly and if so to try to identify the determining factors. Methods: All patients undergoing colorectal surgery between 1975 and 1990 were entered into a computerized database. Patients were divided into two groups, those less than 80 years (< 80) and those 80 years and more (80+), and compared with regard to the type of surgery performed, the patient's race, the seniority of the surgeon, the patient's disease, the operation performed and the postoperative morbidity and mortality. In addition, patients undergoing major resectional surgery and patients undergoing colorectal cancer surgery were compared separately.Results: Of 201 1 admissions, 88 were for patients of 80-t. The male to female admission rate was 1 : 0.79 in the < 80 group and 1 : 1.25 in the 80+ group. More surgical procedures were performed by consultants in older patients. More emergency admissions were for 80+ patients. Rectal, sigmoid and right colonic pathology was more common in the elderly. Very few elderly patients were admitted with minor anorectal problems. Rectal prolapse and colorectal cancer were the commonest causes for admission in octogenarians. There were more pulmonary and cardiovascular postoperative complications in 80+ patients. Urinary tract infections were also more common. The postoperative mortality rate was higher in older patients (7.9 vs 1.4%). Four hundred and sixty-two patients underwent major resectional surgery and 45 were 80+. Surgery for diverticular disease was more frequent in younger patients (13.4 vs 2.2%) and cancer surgery in older patients (93.3 vs 70.5%). The postoperative mortality rate was higher in the elderly (1 1.1 vs 3.6%). Three hundred and thirty-six major resections were for cancer and 42 were 80+. Emergency surgery was performed more commonly in the older group (38.1 vs 14.9%). The rate of advanced disease seemed to be similar in both groups. The postoperative death rate was higher in the elderly (11.9 vs 3.4%). Conclusions: Elderly patients were more likely to die from cardiopulmonary problems after surgical interventions than either from their primary disease or from the surgery undertaken for it. Good postoperative cardiopulmonary support should thus be provided for all such patients.

Colorectal cancer in the elderly: characteristics and short term results

“…In other series, complicated forms of the disease reached figures similar to our data, in patients aged 80 or above (5,6,14,18,20).…”

“…The increase of female patients as a function of age is also found in other series and is explained by the higher life expectancy of women (15). As has been described previously (5,(16)(17)(18)(19)(20), more than 60% of patients aged 80 or older had associated comorbidities. Similarly, there was an increase in perioperative risk (ASA grade) with age.…”

Early postoperative results of surgery for rectal carcinoma as a function of the distance of the tumor from the anal verge: results of a multicenter prospective evaluation

“…In a multivariate analysis Petersen et al [29] identified anastomotic leak as a significant independent factor for local recurrence but found no significant effect of leak on survival rate. Further risk factors for leaks or increased morbidity and mortality rates have been identified to be smoking, alcohol abuse, and advanced age (>80 years) [30,31,32,33,34,35,36,37]. Isbister [34] found a mortality rate of 11.1% in patients older than 80 years, as compared with 3.6% in younger patients.…”

Nichtonkologische Viszeralchirurgie im Alter

“…Wie eine Studie aus Neuseeland zeigte, muss bei (sehr) alten Patienten mit kolorektalen Erkrankungen prinzipiell von einer signifikant erhöhten Morbidität und Letalität ausgegangen werden, wenn man diese Patientenpopulation mit einer beliebig jüngeren vergleicht [9]. Die Todesfälle traten dabei überwiegend aufgrund von kardiopulmonalen Komplikationen in der postoperativen Phase ein und konnten nicht der kolorektalen Grunderkrankung oder einer unmittelbar chirurgischen Komplikation angelastet werden.…”