Perioperative Morbidity and Mortality Among Elderly and Octogenarian Patients Undergoing Major Abdominal Surgery.

Abstract

Introduction: The global population is aging and life expectancy is increasing rapidly. As a consequence, the need of major abdominal surgeries increases as well. However, due to the advanced age, such surgeries are characterized by high morbidity and mortality rates, which proportionately increase with age.

Aim: To investigate perioperative morbidity and mortality rates and identify their relative prognostic factors among elderly and octogenarian patients undergoing major abdominal surgery.

Material and method: A total of 321 patients who underwent major abdominal surgery in the Second Department of Propaedeutic Surgery of Laiko General Hospital in Athens, Greece, were prospectively reviewed. The sample was divided into two groups. Group A included 254 (79.1%) elderly patients aged 65 to 79 years and Group B, 67 (20.9%) patients aged 80 years and over. Data was collected between June 2021 and June 2024 via patients' medical records using a recording form which included demographic and medical characteristics, morbidity factors such as duration of hospitalization, Dindo-Clavien classification, need of transfer to the intensive care unit (ICU) and survival outcome.

Results: There was no difference in baseline characteristics, including gender (p=0.094) and preoperative ASA (American Society of Anesthesiologists) classification (p=0.096), between the two groups. Absence of comorbidities was found only in Group A (p=0.010), while in Group B there were higher percentages of patients with more than two comorbidities, especially pathological ones (p=0.011), compared with Group A (p=0.006). Regarding the type of surgery (emergency or elective), there was no difference between the two study groups (p>0.05), but colectomy and gastrectomy were more prevalent among patients in Group B, while hepatectomy and pancreatectomy were more prevalent in Group A (p=0.018). We found no difference in perioperative morbidity factors, including duration of hospitalization (p=0.841), the need for ICU transfer (p=0.166) and perioperative complications based on Dindo-Clavien classification (p=0.228). However, fatality rates were higher in Group B than Group A (10.4% vs. 3.5%, p=0.030), with correlation analysis showing a positive correlation between Group B and mortality (rs=0.129, p=0.021), indicating that age ≥80 years was directly affecting mortality. Morbidity factors were found to be independent risk factors of each other (p<0.05) for both study groups and ASA score was a direct predictor for morbidity among octogenarian patients, while the type of surgery was a direct predictor for ICU transfer among the elderly ones (p<0.05). Postoperative complications were a direct predictor of mortality for both groups (p<0.001), while ASA classification (p=0.011) and hospitalization duration (p<0.001) were direct mortality predictors for the elderly subjects and ICU transfer for octogenarian ones (p=0.005).

Conclusions: Advanced age is associated with higher rates of mortality, which in turn is affected by both perioperative morbidity and preoperative ASA scores.