[Day care varicose vein surgery in elderly patients. 10 years of experience].

At present the surgical treatment of lower limb varicose veins is performed mainly as day case surgery. Since 30% of elderly people suffer from this disease, the feasibility of phlebological operations in elderly patients in a day care setting is an emerging problem. All patients (2032 patients) who underwent varicose vein surgery in our Geriatric Surgery Department over a 10-year period from January 1993 to December 2002 were evaluated retrospectively; 312 patients (15.35%) were aged above sixty-five years. In this group of elderly patients, 214 (68.6%) were operated on as inpatients and 98 (31.4%) as day care cases; in the younger group, 60.23% were treated in a day care regimen. All patients were examined and selected depending on general conditions, local conditions and logistics. Among the general conditions the exclusion criteria for elderly patients were concomitant diseases (43.9%) and anxiety (17.8%); as a consequence of local conditions, 31 patients (14.5%) with extensive bilateral varices and 27 patients (12.6%) with complicated recurrent disease were excluded from day care surgery; 24 patients (11.2%) were excluded because of logistics. Almost half (44.9%) of the elderly patients required multiple admissions for diagnostic investigations. The elderly patients underwent fewer saphenous strippings (7.1% vs 15.9%) and below-knee strippings (48.0% vs 56.9%); on the other hand, there were more operations on perforating veins (7.1% vs 1.4%), more varicectomies 10.2% vs 1.7%) and more skin grafts for ulcers (8.2% vs 2.2%). No problems occurred during the interventions and none of the patients had to be re-admitted to hospital for complications. This study provides evidence that varicose veins can be safely managed in a day care unit even in elderly patients, though careful preoperative selection is necessary.