The Effect of Age on the Risk for Complications and Death after Noncardiac Surgery

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The summary below is from the full report titled "Impact of Age on Perioperative Complications and Length of Stay in Patients Undergoing Noncardiac Surgery." It is in the 17 April 2001 issue of Annals of Internal Medicine (volume 134, pages 637-643). The authors are CA Polanczyk, E Marcantonio, L Goldman, LEP Rohde, J Orav, CM Mangione, and TH Lee.

What is the problem and what is known about it so far?

As the U.S. population ages, major surgical procedures are being done more and more often in older patients. Some research shows that older patients have more surgical complications and higher risk for dying after surgery than younger patients. However, precise descriptions of the number and types of complications experienced by older people have not been available.

Why did the researchers do this particular study?

The researchers wanted to describe the risk for complications in people having elective surgery and the risk for dying after surgery. They also wanted to see whether complications and death after surgery were more common in older people than younger people.

Who was studied?

The study included 4315 men and women 50 years of age or older. All of the participants had major surgery from 1989 to 1994 at a single Boston hospital. None of their surgeries were emergency procedures, and no surgeries involved the heart.

How was the study done?

The researchers interviewed patients before surgery and 1 and 6 months after surgery. They asked standard questions about their medical history and daily activity level. After surgery, the researchers reviewed medical records and laboratory tests to see how long patients had stayed in the hospital and whether patients had had complications.

What did the researchers find?

Major or fatal complications occurred in 4% of patients younger than 59 years of age, 6% of patients 60 to 69 years old, 10% of patients 70 to 79 years old, and 13% of patients 80 years of age or older. Major complications included heart problems (such as chest pain, heart attack, and abnormal heart rhythms), lung problems (such as pneumonia, inability to breathe, and blood clots), kidney problems requiring dialysis, and strokes. Compared with patients younger than 80 years of age, patients 80 years of age or older stayed 1 day longer in the hospital. Rates of death after surgery were 1% among patients younger than 80 years of age and 3% among those 80 years of age or older.

What were the limitations of the study?

The study was done at a single hospital in Boston. It involved mostly patients who were white, and it looked at elective rather than emergency operations. The experience may be different in other hospitals, for patients from other ethnic groups, and with other types of surgery. Some of the surgeries were performed 8 to 10 years ago; assessment of patients before surgery, surgical techniques, and care after surgery may have improved since then.

What are the implications of the study?

Older patients undergoing elective surgery other than heart surgery have more complications after surgery than do younger patients who undergo the same types of surgery. However, even in patients 80 years of age or older, rates of death were quite low.