[General surgery in the octogenarian patient. One year's clinical experience].

BACKGROUND

As the number of people over the age of 80 years is rapidly increasing, it may be expected that demand for surgical care for the elderly will also rise during the next decade thus contributing to a change in surgeon attitude.

AIM OF THE STUDY

Because little literature is available on the surgical care requested by the over eighties, the aim of this study is to focus on the present surgical demand of the octogenarians in general surgical practice.

METHODS

Two hundred-five admissions of 187 patients of above 80 years during one year were recorded retrospectively and statistical evaluation (Fisher exact test or Chi square test) of main clinical features was performed.

RESULTS

The rate of surgical admission of octogenarians was 6.5% (205/3135). Half of the patients were admitted as emergencies (52.7%). This percentage was significantly higher (p < 0.000) than in < 80 year old patients (20.8%). The mortality rate for all admissions was 11.2%. In 65.4% of cases a surgical procedure was necessary with a correlated mortality rate of 8.2%. The mortality (2.9%) and morbidity (17%) rate in elective surgery were significantly lower (p = 0.0176 and p = 0.003 respectively) than in emergency surgery (13.6% and 42% respectively). Of all admissions 74.4% were uneventful and, in patients who underwent surgery, complications occurred in 29.8% with no statistically significant differences between patients with or without coexisting disease. The mean hospital stay was 11.4 days and in operated patients was 14.4 days. Almost the total number of patients could be sent home directly.

CONCLUSIONS

In octogenarians, surgery is performed more frequently when a complication occurs, but this attitude should be changed because the mortality and morbidity rate are significantly higher. New standards of management and new resources will be requested for the elective surgical care of this rapidly increasing aged group of patients.