Five‐year survival after surgery in nonagenarian patients

Aim The number of nonagenarians undergoing surgery has increased considerably in recent decades as a result of population aging. Greater knowledge of the most influential factors affecting perioperative morbidity and mortality would improve the quality of care and provision of health resources for these patients. The objective of the present study was to analyze the perioperative mortality, and its most determinant factors, among nonagenarian patients who underwent a surgical procedure in the Department of General and Digestive Surgery. Methods A retrospective descriptive study was carried out in a cohort of 159 consecutive non‐selected surgical nonagenarian patients. Clinical data, type of operation, perioperative hemodynamic instability, the need for blood transfusion and medical/surgical complications were evaluated as predictor variables. The outcome variable was operative mortality. Results The mean age was 91.8 years (SD ± 2.0); there were 60 men (37.7%) and 99 (62.3%) women. Perioperative mortality was 28.93% (46 patients). The variables age (P = 0.025), American Society of Anesthesiologists physical status score (P < 0.001), neoplastic pathology (P = 0.025), intestinal surgery (P = 0.001), emergent surgery (P ≤ 0.001), perioperative blood transfusion (P = 0.003), postoperative medical complications (P < 0.001) and surgical complications (P = 0.022) showed a statistically significant correlation with mortality. American Society of Anesthesiologists physical status score (P = 0.007), emergent surgery (P < 0.032) and perioperative blood transfusion (P = 0.047) were identified as independent predictors of mortality. Conclusions Surgery should not be denied to nonagenarian patients based only on their age. Emergency surgery and American Society of Anesthesiologists physical status classification are the most significant factors when deciding whether to intervene. Geriatr Gerontol Int 2019; 19: 293–298.

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“…The 1‐, 3‐ and 5‐year survival rates were 60%, 36% and 24%, respectively; these data have been published previously …”

Section: Resultssupporting

confidence: 79%

Emergency surgery and American Society of Anesthesiologists physical status score are the most influential risk factors of death in nonagenarian surgical patients

Fariña-Castro

Roque‐Castellano

Artíles-Armas

et al. 2019

Geriatrics Gerontology Int

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“…This concept is also in agreement with the definition of health proposed by the World Health Organization; it is not a lack of disease or ailment but rather a state of well-being that encompasses physical, mental and social welfare. It is pivotal to preserve a patient's functional status and independence whilst at the same time minimizing the morbidity and mortality risks that they might be exposed to [6][7][8].…”

Section: Preoperative Assessment and Treatment Decisionsmentioning

confidence: 99%

Colon cancer in the older population

Kenig

2021

Nowotwory. Journal of Oncology

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Fifty percent of new diagnoses of colorectal cancer are made in patients aged over 70 years, and 25% are aged 80 years or over. Older patients tend to have locally advanced colon cancer, with negative lymph nodes and without distant metastasis. Frequently the colon cancer is located on the right side. There is still a belief that older patients can not manage curative treatment regimens. This is based on the results of older studies showing higher rates of short-term morbidity and mortality. At present, we are observing significant improvements in the outcomes of older patients with colon cancer in high volume centers. This could be due to better preoperative staging, increased use of minimally invasive techniques, better anesthesiology and perioperative care, awareness of complications, expertise and high-volume care. A standardized pre-operative diagnostic approach, individualized surgical technique selection and tailored postoperative care are essential for the successful treatment of older patients. Furthermore, counseling and shared decision-making should be based on modern insights in surgical outcomes rather than outdated data.

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“…Advanced age is associated with physiological derangements and a greater burden of comorbidity. The estimated postoperative survival rates after surgery for nonagenarians at one, 3–5 years are 59.6, 35.8 and 24.1%, respectively ( 5 , 6 ). Such studies, however, have examined individuals undergoing non-cardiac surgery, ( 7 , 8 ) and have not provided granular insights into the anesthetic and peri-operative course of cardiac surgical patients.…”

Section: Introductionmentioning

confidence: 99%

“…0:6.8),[4][5][6][7][8][9] 6.0 (5.0:6.2),[5][6][7][8][9][10] Binary variables are presented as n (%) patients, and numerical variables are presented as Mdn [interquartile range], range (minimum-maximum). MMM, modified monash model; SEIFA (IRSAD), socio-economic indexes for areas (index of relative socio-economic advantage and disadvantage); CSHA, Canadian study of health and ageing; PCI, percutaneous coronary intervention; NYHA, New York heart association; TIA, transient ischemic attack; CCI, charlson comorbidity index.…”

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confidence: 99%

Modern Cardiac Surgical Outcomes in Nonagenarians: A Multicentre Retrospective Observational Study

Weinberg

Walpole

Lee

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThere have been multiple recent advancements in the selection, optimisation and management of patients undergoing cardiac surgery. However, there is limited data regarding the outcomes in nonagenarians, despite this cohort being increasingly referred for these interventions. The objective of this study was to describe the patient characteristics, management and outcomes of a cohort of nonagenarians undergoing cardiac surgery receiving contemporary peri-operative care.MethodsAfter receiving ethics approval, we conducted a retrospective observational study of nonagenarians who had undergone cardiac surgery requiring a classic median sternotomy. All operative indications were included. We excluded patients who underwent transcatheter aortic valve implantation (TAVI), and surgery on the thoracic aorta via an endovascular approach (TEVAR). Patients undergoing TEVAR often have the procedure done under sedation and regional blocks with local anesthetic solution. There is no open incision and these patients do not require cardiopulmonary bypass. We also excluded patients undergoing minimally invasive mitral valve surgery via a videoscope assisted approach. These patients do not have a median sternotomy, have the procedure done via erector spinae block, and often are extubated on table. Data were collected from four hospitals in Victoria, Australia, over an 8-year period (January 2012–December 2019). The primary objective was to assess 6-month mortality in nonagenarian patients undergoing cardiac surgery and to provide a detailed overview of postoperative complications. We hypothesized that cardiac surgery in nonagenarian patients would be associated with a 6-month postoperative mortality <10%. As a secondary outcome, we hypothesized that significant postoperative complications (i.e., Clavien Dindo Grade IIIb or greater) would occur in > 30% of patients.ResultsA total of 12,358 adult cardiac surgery patients underwent surgery during the study period, of whom 18 nonagenarians (0.15%) fulfilled inclusion criteria. The median (IQR) [min-max] age was 91.0 years (90.0:91.8) [90–94] and the median body mass index was 25.0 (kg/m2) (22.3:27.0). Comorbidities, polypharmacy, and frailty were common. The median predicted mortality as per EuroSCORE-II was 6.1% (4.1:14.5). There were no cases of intra-operative, in-hospital, or 6-month mortality. One (5.6%) patient experienced two Grade IIIa complications. Three (16.7%) patients experienced Grade IIIb complications. Three (16.7%) patients had an unplanned hospital readmission within 30 days of discharge. The median value for postoperative length of stay was 11.6 days (9.8:17.6). One patient was discharged home and all others were discharged to an inpatient rehabilitation facility.ConclusionIn this selected, contemporary cohort of nonagenarian patients undergoing cardiac surgery, postoperative 6-month mortality was zero. These findings support carefully selected nonagenarian patients being offered cardiac surgery (Trials Registry: https://www.anzctr.org.au/ACTRN12622000058774.aspx).

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Five‐year survival after surgery in nonagenarian patients

Cited by 19 publications

References 26 publications

Emergency surgery and American Society of Anesthesiologists physical status score are the most influential risk factors of death in nonagenarian surgical patients

Emergency surgery and American Society of Anesthesiologists physical status score are the most influential risk factors of death in nonagenarian surgical patients

Colon cancer in the older population

Modern Cardiac Surgical Outcomes in Nonagenarians: A Multicentre Retrospective Observational Study

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