Abstract
Background
Important trade-offs of risks versus benefits of surgery need to be discussed with
older adults, in particular nonagenarians who are candidates for surgery. Data that
examine specific outcomes of surgical interventions in this age group are sparse.
We aimed to evaluate the clinical presentation and postoperative outcomes of nonagenarians
undergoing surgery.
Methods
A retrospective cohort study of consecutive patients 90 years of age and older who
underwent surgery between 2014 and 2018 in general surgical ward of a large-volume
academic center. Subgroups were designed according to type of surgery (elective versus
emergency surgery) and diagnosis (oncology versus non-oncology).
Preoperative assessments included Malnutrition Universal Screening Tool, Norton Scale,
Morse Scale, Katz, and Lawton-Brody indices.
Results
A total of 198 nonagenarians underwent surgery, of which 38% were elective and 62%
were emergency surgery. Median follow-up was 26 months. More patients in the elective
group compared with the emergency group had oncology diagnoses (42.1% and 14.7%, respectively,
P < .001), resided preoperatively at home (93.4% and 77.9%, respectively, P = .003), and were functionally independent (71.1% and 41.8%, respectively, P = .0005). Postoperative 30-day mortality frequency was 6.6% in the elective group
and 39.3% in the emergency group (P < .001). Two-year survival frequency of non-oncology group was 72.7% in elective
surgeries and 40.6% in emergency surgeries (P < .001). Two-year survival frequency of oncology group was 37% in elective surgeries
and 27.8% in emergency surgeries (P = .12).
Conclusion
Elective surgery in adults aged 90 and above can be safely performed with acceptable 2-year
outcomes. Emergency surgery for oncology diagnoses carries dismal outcomes, so palliative
approaches should be considered.
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Article info
Publication history
Published online: January 22, 2022
Accepted:
September 27,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
