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Risk Factors for Mortality in Major Digestive Surgery in the Elderly

2011; Lippincott Williams & Wilkins; Volume: 254; Issue: 2 Linguagem: Inglês

10.1097/sla.0b013e318226a959

1528-1140

J J Duron, Emmanuelle Duron, T. Dugue, José Pujol, Fabrice Muscari, Denis Collet, Patrick Pessaux, Jean‐Marie Hay,

Colorectal Cancer Surgical Treatments

In Brief Objective: To identify the mortality risk factors of elderly patients (≥65 years old) during major digestive surgery, as defined according to the complexity of the operation. Background: In the aging populations of developed countries, the incidence rate of major digestive surgery is currently on the rise and is associated with a high mortality rate. Consequently, validated indicators must be developed to improve elderly patients' surgical care and outcomes. Methods: We acquired data from a multicenter prospective cohort that included 3322 consecutive patients undergoing major digestive surgery across 47 different facilities. We assessed 27 pre-, intra-, and postoperative demographic and clinical variables. A multivariate analysis was used to identify the independent risk factors of mortality in elderly patients (n = 1796). Young patients were used as a control group, and the end-point was defined as 30-day postoperative mortality. Results: In the entire cohort, postoperative mortality increased significantly among patients aged 65–74 years, and an age ≥65 years was by itself an independent risk factor for mortality (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.36–3.59; P = 0.001). The mortality rate among elderly patients was 10.6%. Six independent risk factors of mortality were characteristic of the elderly patients: age ≥85 years (OR, 2.62; 95% CI, 1.08–6.31; P = 0.032), emergency (OR, 3.42; 95% CI, 1.67–6.99; P = 0.001), anemia (OR, 1.80; 95% CI, 1.02–3.17; P = 0.041), white cell count > 10,000/mm3 (OR, 1.90; 95% CI, 1.08–3.35; P = 0.024), ASA class IV (OR, 9.86; 95% CI, 1.77–54.7; P = 0.009) and a palliative cancer operation (OR, 4.03; 95% CI, 1.99–8.19; P < 0.001). Conclusion: Characterization of independent validated risk indicators for mortality in elderly patients undergoing major digestive surgery is essential and may lead to an efficient specific workup, which constitutes a necessary step to developing a dedicated score for elderly patients. The frequency of major digestive surgery, which is associated with a high mortality rate, is on the rise. Through a multicenter prospective cohort, we identified several characteristic risk factors of mortality in patients older than 65 years of age. Our results suggest a need for specific surgical workups.