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Post‐operative outcomes in older patients: a single‐centre observational study
Author(s) -
Tang Benjamin,
Green Cameron,
Yeoh Aun Chian,
Husain Faisal,
Subramaniam Ashwin
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14433
Subject(s) - medicine , observational study , american society of anesthesiologists , intensive care unit , adverse effect , retrospective cohort study , pediatrics , emergency medicine , surgery
Background Improved life‐expectancies have seen increased rates of older patients undergoing surgery worldwide. These patients are at increased risk of post‐operative complications. Australian evidence is limited regarding the association between age and post‐operative outcomes, especially rapid response calls (RRCs) as indicators of adverse outcomes. The aim was to compare the post‐operative outcomes of older patients (≥80 years) to younger patients. Specifically, 30‐day in‐hospital mortality; unplanned intensive care unit (ICU) admission; and RRC activation within 72 h post‐operatively. Methods Single‐centre retrospective observational study conducted over 12 months in a metropolitan Australian hospital. All adult patients (≥16 years) undergoing surgical procedures were included, excluding cardiac and obstetric/gynaecological surgeries. Patient co‐morbidities were quantified using Charlson co‐morbidity index (CCI) and American Society of Anesthesiologists physical status classification. Results Seven thousand four hundred and seventy‐nine patients met inclusion criteria, 14.5% ( n = 1086) aged ≥80 years. Most procedures (65%) were elective; and general surgical procedures were most common (24.2%). Compared to younger patients, older patients had significantly higher 30‐day mortality (2.3% versus 0.2%; P < 0.001), increased post‐operative RRC rates (7.3% versus 1.2%; P < 0.001), and unplanned ICU admissions (3.2% versus 1.6%; P < 0.001). Increasing age was associated with increased risk of post‐operative RRC, unplanned ICU admission, and in‐hospital mortality (all P < 0.01), with associations remaining significant after controlling for surgery type and CCI. Conclusion Older patients are at increased risk of adverse post‐operative outcomes, including post‐operative RRC, unplanned ICU admission, and mortality, especially if they underwent emergency procedures. This has implications for preoperative risk stratification and post‐operative management. Incidence of post‐operative RRCs may be an important indicator of post‐operative care.