Content area
Full Text
The increasing range of surgery in elderly patients reflects the changing demography where in the next 10 years one quarter of the population will be 65 years of age or older. There is presently no consensus concerning the optimal predictive markers for postoperative morbidity and mortality after surgery in older patients with an appreciation that physical frailty is more important than chronological age. In this retrospective analysis, we have compared the impact of age and the calculated preoperative Charlson Comorbidity Index (CCI) on early (30-day) and late (one-year) mortality in a group of patients >75 years of age dividing them into an "older old" cohort (75-84 years of age, Group A) and an "oldest old" group (≥85 years of age, Group B). Increased age was associated with a higher death rate after emergency surgery, with late deaths after elective surgery exceeding those after emergency operations. A higher mean CCI was noted in both age groups in early nonsurvivors after both elective and emergency surgery with a more significant effect of the preoperative CCI than chronological age for the prediction of late postoperative death for both groups after elective and emergency operations. Although the CCI was not designed to predict perioperative mortality in surgical cohorts, it correlates with a greater risk than age for perioperative death in the elderly.
BYTHEYEAR2025, it has been estimated thatabout one quarter of the population will be 65 years or older with Israeli society reflecting this worldwide changing demographic.1-3 Older patients constitute an increasing proportion of emergency and elective surgical cases,4 and elderly surgical patients have a higher rate of comorbidity when compared with their younger counterparts, with comparatively longer hospital stays, higher complication rates, greater intensive care usage, and the generation of higher overall costs. A range of risk factors in older patients for both postoperative complications and mortality have been identified including age,5, 6 the American Society of Anesthesiologists' (ASA) grade,7 and the need for an emergent procedure.5, 7, 8 Isolated predictors, however, may fail to accurately forecast the relative postoperative risk (outside of the threat of death) in these complex patients for other outcomes such as worsening disability and/or institutionalization after surgery.
In an effort to define these risks preoperatively, frailty indices have been devised to more...