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Elderly Health

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Elderly patients have more complications and are more likely to die after noncardiac surgery than younger patients

Elderly patients who undergo noncardiac surgery have a higher rate of complications and death and stay in the hospital an average of 1 day longer than similar non-elderly patients. However, even in patients age 80 and older, the rate of complications is not prohibitive, and mortality is still low, according to a study supported by the Agency for Healthcare Research and Quality (HS06573). These findings suggest the need to develop strategies to reduce postsurgical complications and improve physical recovery of elderly patients after noncardiac surgery, conclude Thomas H. Lee, Jr., M.D., M.S., of Harvard Medical School, and Lee Goldman, M.D., M.P.H., of the University of California School of Medicine, San Francisco.

The researchers studied the medical charts of 4,315 patients 50 years of age or older who underwent nonemergency major noncardiac procedures at an urban medical center to identify perioperative complications, in-hospital mortality, and length of hospital stay. Patients 70 to 79 years of age had nearly double the likelihood of perioperative complications or in-hospital death (odds ratio, OR 1.8), and those 80 years of age or older had slightly more than double the likelihood of such problems (OR 2.1) compared with younger patients.

For example, major cardiac and noncardiac perioperative complications occurred in 4.3 percent of patients aged 59 or younger, 5.7 percent of patients 60 to 69 years of age, 9.6 percent of patients 70 to 79 years of age, and 12.5 percent of patients aged 80 or older. In-hospital mortality was significantly higher in patients 80 years of age or older than in younger patients (2.6 vs. 0.7 percent), and they stayed an average of 1 day more in the hospital. Major cardiac complications ranged from unstable angina and heart attack to cardiac arrest. Major noncardiac complications ranged from pulmonary embolism and respiratory failure to acute renal failure or stroke.

See "Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery," by Carisi A. Polanczyk, M.D., Sc.D., Edward Marcantonio, M.D., M.S., Dr. Goldman, and others, in the April 17, 2001, Annals of Internal Medicine 134(8), pp. 637-643.

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