Impact of Age on Perioperative Complications and Length of Stay in Patients Undergoing Noncardiac Surgery

Impact of Age on Perioperative Complications and Length of Stay in Patients Undergoing Noncardiac Surgery

Carísi A. Polanczyk, MD, ScD;
Edward Marcantonio, MD, MS;
Lee Goldman, MD, MPH;
Luis E.P. Rohde, MD, ScD;
John Orav, PhD;
Carol M. Mangione, MD, MPH; and
Thomas H. Lee, MD, ScD

From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and the University of California, San Francisco, School of Medicine, San Francisco, California.

Abstract

Background: Major surgical procedures are performed with increasing frequency in elderly persons, but the impact of age on resource use and outcomes is uncertain.

Objective: To evaluate the influence of age on perioperative cardiac and noncardiac complications and length of stay in patients undergoing noncardiac surgery.

Design: Prospective cohort study.

Setting: Urban academic medical center.

Patients: Consecutive sample of 4315 patients 50 years of age or older who underwent nonemergent major noncardiac procedures.

Measurements: Major perioperative complications (cardiac and noncardiac), in-hospital mortality, and length of stay.

Results: Major perioperative complications occurred in 4.3% (44 of 1015) of patients 59 years of age or younger, 5.7% (93 of 1646) of patients 60 to 69 years of age, 9.6% (129 of 1341) of patients 70 to 79 years of age, and 12.5% (39 of 313) of patients 80 years of age or older (P < 0.001). In-hospital mortality was significantly higher in patients 80 years of age or older than in those younger than 80 years of age (0.7% vs. 2.6%, respectively). Multivariate analyses indicated an increased odds ratio for perioperative complications or in-hospital mortality in patients 70 to 79 years of age (1.8 [95% CI, 1.2 to 2.7]) and those 80 years of age or older (OR, 2.1 [CI, 1.2 to 3.6]) compared with patients 50 to 59 years of age. Patients 80 years of age or older stayed an average of 1 day more in the hospital, after adjustment for other clinical data (P = 0.001).

Conclusions: Elderly patients had a higher rate of major perioperative complications and mortality after noncardiac surgery and a longer length of stay, but even in patients 80 years of age or older, mortality was low.

Article and Author Information

Grant Support: By grant RO1-HS06573 from the Agency for Health Care Policy and Research, Rockville, Maryland.
Requests for Single Reprints: Thomas H. Lee, MD, Partners Community HealthCare, Inc., Prudential Tower, 11th Floor, 800 Boylston Street, Boston, MA 02199; e-mail, thlee{at}partners.org.
Current Author Addresses: Drs. Polanczyk and Rohde: Hospital de Clinicas de Porto Alegre, Ramiro Barcelos 2350/2225, Porto Alegre, RS 9000, Brazil.
Dr. Marcantonio: Hebrew Rehabilitation Center for the Aged, 1200 Centre Street, Boston, MA 02131.
Dr. Goldman: University of California, San Francisco, School of Medicine, 505 Parnassus Avenue, San Francisco, CA 94143-0120.
Dr. Orav: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Dr. Mangione: University of California, Los Angeles, School of Medicine, 911 Broxton Plaza, Los Angeles, CA 90095.
Dr. Lee: Partners Community HealthCare, Inc., Prudential Tower, 11th Floor, 800 Boylston Street, Boston, MA 02199.
Author Contributions: Conception and design: C.A. Polanczyk, E. Marcantonio, L. Goldman, L.E.P. Rohde, C.M. Mangione, T.H. Lee.
Analysis and interpretation of the data: C.A. Polanczyk, E. Marcantonio, L. Goldman, L.E.P. Rohde, E.J. Orav, T.H. Lee.
Drafting of the article: C.A. Polanczyk, L.E.P. Rohde, T.H. Lee.
Critical revision of the article for important intellectual content: C.A. Polanczyk, E. Marcantonio, L. Goldman, L.E.P. Rohde, E.J. Orav, C.M. Mangione, T.H. Lee.
Final approval of the article: C.A. Polanczyk, E. Marcantonio, L. Goldman, L.E.P. Rohde, E.J. Orav, C.M. Mangione, T.H. Lee.
Provision of study materials or patients: L. Goldman, T.H. Lee.
Statistical expertise: C.A. Polanczyk, E.J. Orav, T.H. Lee.
Obtaining of funding: L. Goldman, T.H. Lee.
Administrative, technical, or logistic support: L. Goldman, T.H. Lee.
Collection and assembly of data: E. Marcantonio, L. Goldman, C.M. Mangione, T.H. Lee.