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Postoperative complications in the elderly surgical patient
Postoperative THOMAS
J. KLUG,
M.D.,
Complications in the Elderly Surgical Patient Hurlingen,
Texas, AND CAPT. RICHARD C. MCPHERSON, MC, USAF,* Columbus, Ohio
From tbe Department of Surgery and tbe Medical Center of The Ohio State University College of Medicine, Columbus, Obio.
During 1955 there were 723 operations performed upon patients sixty years of age or older on the genera1 surgicaI service. Of 532 major operations, I84 (35 per cent) were foIIowed by one or more compIications. In comoperations upon of 1,169 major parison, patients under sixty years of age during the same period, 272 (23 per cent) were folIowed by one or more complications. Of the minor operations performed upon eIderIy patients, I I per cent resulted in one or more compIications, while onIy 4 per cent of minor operations upon younger patients were foIIowed by comphcations. There were forty-five deaths foIIowing the 532 major operations in the eIderIy age group, giving a postoperative mortality of 8.5 per cent. In patients under sixty years of age who had major operations during this time the postoperative mortaIity was 4 per cent. PuImonary compIications were present in about haIf of the eIderIy patients who died. Wound, urinary and misceIIaneous compIications occurred in onIy a few patients who died. No effort was made to divide these operations into emergency or elective procedures. It is, of course, we11 known that the mortality and morbidity rates foIlowing emergency surgery in eIderIy patients are much higher than those foIIowing eIective surgery [ r,2].
LTHOUGH a great deaI has been written about the elderIy surgica1 patient, the literature deals primarily with mortality and preoperative and postoperative care. Comparatively IittIe information is available concerning postoperative comphcations in this group of patients. The need for such a study became apparent after it was recently shown on this surgicaI service that the incidence of conpostoperative complications increases siderably in patients sixty years of age and over [d]. It was also shown that one of three major operations during rg55 was performed upon a patient sixty years of age or over, adding further importance to such an investigation. This report is concerned primarity with compIications fohowing major operations in patients of advanced years.
A
METHODS The charts of patients sixty years of age or older having surgery performed on the general surgical service during 1955 were reviewed. One standard comprehensive Iist of complications was appIied to a11 of the charts studied. Each record was examined compIeteIy and many additiona complications were discovered which had not been recorded originally, either by oversight or by Iack of a uniform definition of a postoperative compIication. Any compIication occurring during a patient’s hospita1 stay was incIuded regardless of the Iength of time after operation. The specialties of orthopedics, neurosurgery, uroIogy, gynecoIogy and pIastic and thoracic surgery were not included. * Present
address:
TusIog,
INFLUENCE
OF
SEX
AND
POSTOPERATIVE
ECONOMIC
STATUS
ON
COMPLICATIONS
Of the 532 major operations, 296 were performed upon maIes and 236 upon femaIes. Thirty-nine per cent of the maIes operated upon had postoperative compIications compared to onIy 29 per cent of the femaIes. Major operations performed by the resident Det. No. 34, APO 224, New York, New York. 713
American Journal of Surgery. Volume ~7. June, 1959
KIug and McPherson
% PATIENTS
WITH
COMPLICATIONS
”
70-80
80+
YEARS FIG. 1. Postoperative complications. patients over sixty years of age.
Incidence
staff numbered 220, and the private attending staff accounted for 3 12. Thirty-seven per cent of the eIderly patients operated upon by the resident staff had postoperative complications, while 33 per cent operated upon by the private staff had complications. COMPLICATIONS
BY AGE
Of the 309 major operations performed upon patients between sixty and sixty-nine years of age 105 (34 per cent) resulted in at Ieast one postoperative complication. (Fig. I .) One hundred eighty-two major operations were performed upon patients between seventy and seventy-nine years of age, of which seventy (38 per cent) were folIowed by complications. There were forty-one major operations upon patients who were eighty years of age or over. Nine of these operations resuIted in compIications for an incidence of 22 per cent. INFLUENCE
OF WEIGHT
ABOVE
in
ON POSTOPERATIVE
COMPLICATIONS
It was possibIe to calcuIate the ideal weight of 456 patients sixty years of age or over who underwent major operations. Of 170 patients whose actua1 weight was within IO per cent of the caIcuIated ideal weight, 39 per cent had one or more comphcations. (Fig. 2.) In I 15 patients whose actua1 weight was between IO and 30 per cent above idea1 weight, 29 per cent had postoperative complications. There were fifty-one patients who were 30 per cent or more above ideal weight, of which 47 per cent had comphcations. The 105 operations upon patients whose actua1 weight was between IO and 30 per cent beIow the calcuIated ideal weight had a compIication rate of 30 per cent. While there were onIy fifteen patients whose actua1 weight was more than
FIG. 2. tions.
Influence
IDEAL
of weight on postoperative
BELOW
complica-
30 per cent beIow ideal weight, complications folIowed operation in 27 per cent. This Jatter group is exceedingly smaI1 and the resuhs are not StatisticaIIy significant. These figures agree fairIy we11 with recent studies [G] on this surgica1 service which have shown that there is no significant increase in the incidence of postoperative compIications unti1 the patient’s actua1 weight is 30 per cent above or beIow the idea1 weight. CLASSIFICATION
OF COMPLICATIONS
In aI1, 255 compIications occurred after 184 major operations upon elderly patients. These compJications were divided into six primary types: wound, gastrointestinal, puIurinary and miscardiovascuJar, monary, cellaneous. (Fig. 3.) One of four complications invoIved the wound. Wound abscess, excIuding stitch abscess, was by far the most common complication in this group. Next were wound separations and wound hematomas, each of which was about haIf as frequent. The remainder of the wound compIications encompassed a great variety of conditions. (TabIe I.) The incidence of wound compIications was almost identical with that of patients under sixty years of age operated upon during the same period of time. One of five compIications that occurred in the eJderIy patient was of the gastrointestinaJ type. The intra-abdominal abscess was the most common of this group. (Table II.) Once again it is seen that infection pJays a major role in today’s postoperative probIems. One of six compIications was cIassed in the puImonary group and the most common was that of ateJectasis. (TabIe III.) It was interesting to find that ateJectasis occurred three times
Postoperative TABLE WOUND
CompIications
in the Elderly
Surgical
1955
I
COHAFLKATION
COMPLICATIONS
WlJNo No. of Cases
Type of Complication __
WRDIO-RESPIRATORY
26
MISCELLANEOUSl
II II ”
CARDIOVASCULAR
4
.I
3
URINARY
2
IO 20 30 % OF TOTAL COMPLICATIONS YALIG . ,Hxuxs TEMPOVERloI5-F. ett
2 4
Total.
-OTHERS
FIG. 3. Postoperative
63
TABLE GASTKO
YTESTINAL
II
CAKDIOVASCt
complications
LAH
for the year
1955.
COMPLICATIOUS
COMPLICATIOh-S
Type of Complication
No. of Cases
Type of Complication
__
133
GA!5WfOINTESTWlAL
___~__
Wound abscess. Wound separation Wound hematoma., Skin graft failure.. Necrosis of wound edges.. Evisceration Stitch abscess. Other wound complications.
Patient
..~~
Intra-abdominal abscess.. Obstruction at site of anastomxis. Gastrointestimd hemorrhage Intrap. ritoneat hemorrhage Enterocutaneous IistuIa. : : Persistent ileus.. Generalized peritonitis. I\lechanicaI obstruction. Pancreatitis. Other gastrointestinal complications.
No. of Cases
I Thrombophlebitis. Pulmonary embolus, non-fatal. Pulmonary embolus, fatal Peripheral embolus.. Congestive heart failure Unexplained shock.. Cardiac arrhythmia.. Heart block. Cerebrovascular accident. Coronary thrombosis. Mesenteric thrombosis. .:“.: Other
II 6 6
1 i
;
.I
i 2
7
Total
II
( i
:
‘i 2
5’ Total TABLE
IIL
Type of Complication
AteIectasis.. Pneumonitis. Pleura1 effusion. Pulmonary edema., Pneumothorax........... Subcutaneous emphysema. TotaI.
normal weight, but four times more than the underweight patients. Cardiovascular compJications comprised about 15 per cent of the tota complications. ThrombophIebitis was the most common in this group. (TabIe IV.) Of the puImonary emboh which occurred, one-fourth were fataf. During the year, for all ages, there were four cases of coronary thrombosis postoperativeJy, only one of which occurred in a patient who was sixty years of age or over. Urinary compJications accounted for only one of sixteen postoperative complications. The most common again was that of infection. (Table v.) The misceJJaneous complications were those conditions which could not be satisfactoril) classified in the first five groups. They comprise 18 per cent of the tota complications and the most common in this group was
No. of Cases
~
m
i
10
3 2
I
f 40
more frequentIy in the elderly patient than in patients under sixty years who were operated upon during this period. It was aJso found that ateJectasis was four times more frequent in the eIderIy male than it was in the elderl? female patient. The overweight patients had slightly more ateIectasis than the patients of 7’5
KIug TABLE URINARY
and
McPherson
v
pIains in part this difference in compIication rates. Patients aged eighty years or above had a lower complication rate than those patients between sixty and eighty. It is beIieved that this couId be due to the extent of surgery being tempered in these patients, or more thorough and critica care in the postoperative period because of the age or, as has been aIIuded to in the past, a patient this oId may be constitutionaIIy more sound. Moderate obesity was not associated with a higher complication rate, but those patients whose weight was more than 30 per cent above the idea1 IeveI showed a marked increase in the rate of compIications. Some authors [I,?] have reported that puImonary complications are the most common type in eIderIy patients. This was not the case in this study as both wound and gastrointestina1 compIications were more common than the puImonary type. ProbabIy the most significant difference in specific compIication rates between the young and the old involved ateIectasis, which occurred three times more frequently in patients sixty years of age or over. Whether or not emphysema, chronic Iung disease or a genera1 decrease in pulmonary function accounts for this is diffIcuIt to ascertain. When anaIyzing the complications one is impressed by the frequency of infectious processes which occurred postoperativeIy in fevers are inthese patients. If unexpIained cIuded as being due to some infectious process, 37 per cent of a11 the compIications were due to infection. This does not differ significantIy from the younger group of surgica1 patients. Finding that the morbidity and mortality rates in patients over sixty years of age are significantly higher than in those patients under sixty years of age certainIy suggests the necessity for further investigation into these probIems in the eIderIy patient. A rigid definition and cIass&cation of postoperative compIications is needed in a study of this type. With the heIp of vaIid statistics the exact incidence of postoperative compIications can be determined and technic appIied toward reducing the more common compIications in the eIderIy surgica1 patient.
COMPLICATIONS
Type of Complication
No. of Cases
Urinary infection. Uremia. Lower nephron nephrosis.. Hydronephrosis,
7 4 4 I
Total.............................
16
TABLE VI MISCELLANEOUS COMPLICATIONS
Type of Complication
No. of Cases
-I Unexplained
temperature
over
101.5’~.
Drug alIergy ........................ Psychosis ............................ .......................... Septicemia. Operative rupture of spleen ............ Other.. ...........................
TotaI.............................
34 2 2 2
./
i 47
unexpIained temperature of orally. (TabIe VI.) The others in&de a variety of conditions, occurred without any significant
101.5%. over in this group some of which frequency.
COMMENTS
This rather detaiIed examination of postoperative compIications which occurred after 532 major operations upon patients sixty years of age or oIder has shown severa interesting things. It was found that whereas the frequency of compIications in this group of patients is sign&antIy increased over those patients under sixty years of age, the eIderIy patient was not more prone to any particuIar type of compIication. In other words, the percentage of wound, gastrointestina1, puIcardiovascuIar and urinary commonary, pIications was approximateIy the same in patients under sixty years as it was in patients over sixty years of age. CompIications in the eIderIy maIe patient were more frequent than in the eIderIy femaIe patient. AIso, compIications were more frequent in service patients than in private patients. The higher percentage of poor-risk patients on the cIinica1 service probabIy ex-
SUMMARY I.
A
review
upon patients 716
of 723 operations performed sixty years of age or over on the
Postoperative
Complications
in the
EIderIy
SurgicaI
Patient
5. Extreme obesity (30 per cent or more above idea1 weight) was associated with a higher complication rate but moderateIy obese patients had no increase in complications. 6. Atelectasis was three times more common in elderly patients than in patients under sixty years of age. 7. The need is pointed out for more accurate recording of postoperative complications if proper steps are to be taken to reduce our current complication rate.
general surgical service showed that 523 were major operations, of which 35 per cent were folIowed by one or more postoperative complications. This compared to a 23 per cent comphcation rate in patients under sixty. .years of age for the same time period. The complication rate for minor surgery in the eIderly patients was I I per cent compared to 4 per cent in the younger patients. 2. The mortahty rate fohowing major surgery in the patients sixty years of age and over was 8.5 per cent compared to 4 per cent in the patients under sixty years of age. Pulmonary complications were the most frequentIy encountered type in those patients who died postoperatively. 3. More complications arose in the eIderIy maIe than in the elderly femaIe patient. 4. Wound and gastrointestinal comphcations were the most frequent encountered.
REFERENCES I. HACK, C. A. and DALE, W. A. Major
surgery in old people. Arch. .hrg., 64: 421, 1952. 2. LIMBOSCH, J. Experiences with more than 1,000 eIderIy surgical patients. Arch. Surg., 73: 124, 1956. 3. RANKIN, F. W. and JOHNSTON,C. C. Major operations in elderly patients, Surgery, 5: 763, 1939. 4. Unpublished data.
717
J. KLUG,
M.D.,
Complications in the Elderly Surgical Patient Hurlingen,
Texas, AND CAPT. RICHARD C. MCPHERSON, MC, USAF,* Columbus, Ohio
From tbe Department of Surgery and tbe Medical Center of The Ohio State University College of Medicine, Columbus, Obio.
During 1955 there were 723 operations performed upon patients sixty years of age or older on the genera1 surgicaI service. Of 532 major operations, I84 (35 per cent) were foIIowed by one or more compIications. In comoperations upon of 1,169 major parison, patients under sixty years of age during the same period, 272 (23 per cent) were folIowed by one or more complications. Of the minor operations performed upon eIderIy patients, I I per cent resulted in one or more compIications, while onIy 4 per cent of minor operations upon younger patients were foIIowed by comphcations. There were forty-five deaths foIIowing the 532 major operations in the eIderIy age group, giving a postoperative mortality of 8.5 per cent. In patients under sixty years of age who had major operations during this time the postoperative mortaIity was 4 per cent. PuImonary compIications were present in about haIf of the eIderIy patients who died. Wound, urinary and misceIIaneous compIications occurred in onIy a few patients who died. No effort was made to divide these operations into emergency or elective procedures. It is, of course, we11 known that the mortality and morbidity rates foIlowing emergency surgery in eIderIy patients are much higher than those foIIowing eIective surgery [ r,2].
LTHOUGH a great deaI has been written about the elderIy surgica1 patient, the literature deals primarily with mortality and preoperative and postoperative care. Comparatively IittIe information is available concerning postoperative comphcations in this group of patients. The need for such a study became apparent after it was recently shown on this surgicaI service that the incidence of conpostoperative complications increases siderably in patients sixty years of age and over [d]. It was also shown that one of three major operations during rg55 was performed upon a patient sixty years of age or over, adding further importance to such an investigation. This report is concerned primarity with compIications fohowing major operations in patients of advanced years.
A
METHODS The charts of patients sixty years of age or older having surgery performed on the general surgical service during 1955 were reviewed. One standard comprehensive Iist of complications was appIied to a11 of the charts studied. Each record was examined compIeteIy and many additiona complications were discovered which had not been recorded originally, either by oversight or by Iack of a uniform definition of a postoperative compIication. Any compIication occurring during a patient’s hospita1 stay was incIuded regardless of the Iength of time after operation. The specialties of orthopedics, neurosurgery, uroIogy, gynecoIogy and pIastic and thoracic surgery were not included. * Present
address:
TusIog,
INFLUENCE
OF
SEX
AND
POSTOPERATIVE
ECONOMIC
STATUS
ON
COMPLICATIONS
Of the 532 major operations, 296 were performed upon maIes and 236 upon femaIes. Thirty-nine per cent of the maIes operated upon had postoperative compIications compared to onIy 29 per cent of the femaIes. Major operations performed by the resident Det. No. 34, APO 224, New York, New York. 713
American Journal of Surgery. Volume ~7. June, 1959
KIug and McPherson
% PATIENTS
WITH
COMPLICATIONS
”
70-80
80+
YEARS FIG. 1. Postoperative complications. patients over sixty years of age.
Incidence
staff numbered 220, and the private attending staff accounted for 3 12. Thirty-seven per cent of the eIderly patients operated upon by the resident staff had postoperative complications, while 33 per cent operated upon by the private staff had complications. COMPLICATIONS
BY AGE
Of the 309 major operations performed upon patients between sixty and sixty-nine years of age 105 (34 per cent) resulted in at Ieast one postoperative complication. (Fig. I .) One hundred eighty-two major operations were performed upon patients between seventy and seventy-nine years of age, of which seventy (38 per cent) were folIowed by complications. There were forty-one major operations upon patients who were eighty years of age or over. Nine of these operations resuIted in compIications for an incidence of 22 per cent. INFLUENCE
OF WEIGHT
ABOVE
in
ON POSTOPERATIVE
COMPLICATIONS
It was possibIe to calcuIate the ideal weight of 456 patients sixty years of age or over who underwent major operations. Of 170 patients whose actua1 weight was within IO per cent of the caIcuIated ideal weight, 39 per cent had one or more comphcations. (Fig. 2.) In I 15 patients whose actua1 weight was between IO and 30 per cent above idea1 weight, 29 per cent had postoperative complications. There were fifty-one patients who were 30 per cent or more above ideal weight, of which 47 per cent had comphcations. The 105 operations upon patients whose actua1 weight was between IO and 30 per cent beIow the calcuIated ideal weight had a compIication rate of 30 per cent. While there were onIy fifteen patients whose actua1 weight was more than
FIG. 2. tions.
Influence
IDEAL
of weight on postoperative
BELOW
complica-
30 per cent beIow ideal weight, complications folIowed operation in 27 per cent. This Jatter group is exceedingly smaI1 and the resuhs are not StatisticaIIy significant. These figures agree fairIy we11 with recent studies [G] on this surgica1 service which have shown that there is no significant increase in the incidence of postoperative compIications unti1 the patient’s actua1 weight is 30 per cent above or beIow the idea1 weight. CLASSIFICATION
OF COMPLICATIONS
In aI1, 255 compIications occurred after 184 major operations upon elderly patients. These compJications were divided into six primary types: wound, gastrointestinal, puIurinary and miscardiovascuJar, monary, cellaneous. (Fig. 3.) One of four complications invoIved the wound. Wound abscess, excIuding stitch abscess, was by far the most common complication in this group. Next were wound separations and wound hematomas, each of which was about haIf as frequent. The remainder of the wound compIications encompassed a great variety of conditions. (TabIe I.) The incidence of wound compIications was almost identical with that of patients under sixty years of age operated upon during the same period of time. One of five compIications that occurred in the eJderIy patient was of the gastrointestinaJ type. The intra-abdominal abscess was the most common of this group. (Table II.) Once again it is seen that infection pJays a major role in today’s postoperative probIems. One of six compIications was cIassed in the puImonary group and the most common was that of ateJectasis. (TabIe III.) It was interesting to find that ateJectasis occurred three times
Postoperative TABLE WOUND
CompIications
in the Elderly
Surgical
1955
I
COHAFLKATION
COMPLICATIONS
WlJNo No. of Cases
Type of Complication __
WRDIO-RESPIRATORY
26
MISCELLANEOUSl
II II ”
CARDIOVASCULAR
4
.I
3
URINARY
2
IO 20 30 % OF TOTAL COMPLICATIONS YALIG . ,Hxuxs TEMPOVERloI5-F. ett
2 4
Total.
-OTHERS
FIG. 3. Postoperative
63
TABLE GASTKO
YTESTINAL
II
CAKDIOVASCt
complications
LAH
for the year
1955.
COMPLICATIOUS
COMPLICATIOh-S
Type of Complication
No. of Cases
Type of Complication
__
133
GA!5WfOINTESTWlAL
___~__
Wound abscess. Wound separation Wound hematoma., Skin graft failure.. Necrosis of wound edges.. Evisceration Stitch abscess. Other wound complications.
Patient
..~~
Intra-abdominal abscess.. Obstruction at site of anastomxis. Gastrointestimd hemorrhage Intrap. ritoneat hemorrhage Enterocutaneous IistuIa. : : Persistent ileus.. Generalized peritonitis. I\lechanicaI obstruction. Pancreatitis. Other gastrointestinal complications.
No. of Cases
I Thrombophlebitis. Pulmonary embolus, non-fatal. Pulmonary embolus, fatal Peripheral embolus.. Congestive heart failure Unexplained shock.. Cardiac arrhythmia.. Heart block. Cerebrovascular accident. Coronary thrombosis. Mesenteric thrombosis. .:“.: Other
II 6 6
1 i
;
.I
i 2
7
Total
II
( i
:
‘i 2
5’ Total TABLE
IIL
Type of Complication
AteIectasis.. Pneumonitis. Pleura1 effusion. Pulmonary edema., Pneumothorax........... Subcutaneous emphysema. TotaI.
normal weight, but four times more than the underweight patients. Cardiovascular compJications comprised about 15 per cent of the tota complications. ThrombophIebitis was the most common in this group. (TabIe IV.) Of the puImonary emboh which occurred, one-fourth were fataf. During the year, for all ages, there were four cases of coronary thrombosis postoperativeJy, only one of which occurred in a patient who was sixty years of age or over. Urinary compJications accounted for only one of sixteen postoperative complications. The most common again was that of infection. (Table v.) The misceJJaneous complications were those conditions which could not be satisfactoril) classified in the first five groups. They comprise 18 per cent of the tota complications and the most common in this group was
No. of Cases
~
m
i
10
3 2
I
f 40
more frequentIy in the elderly patient than in patients under sixty years who were operated upon during this period. It was aJso found that ateJectasis was four times more frequent in the eIderIy male than it was in the elderl? female patient. The overweight patients had slightly more ateIectasis than the patients of 7’5
KIug TABLE URINARY
and
McPherson
v
pIains in part this difference in compIication rates. Patients aged eighty years or above had a lower complication rate than those patients between sixty and eighty. It is beIieved that this couId be due to the extent of surgery being tempered in these patients, or more thorough and critica care in the postoperative period because of the age or, as has been aIIuded to in the past, a patient this oId may be constitutionaIIy more sound. Moderate obesity was not associated with a higher complication rate, but those patients whose weight was more than 30 per cent above the idea1 IeveI showed a marked increase in the rate of compIications. Some authors [I,?] have reported that puImonary complications are the most common type in eIderIy patients. This was not the case in this study as both wound and gastrointestina1 compIications were more common than the puImonary type. ProbabIy the most significant difference in specific compIication rates between the young and the old involved ateIectasis, which occurred three times more frequently in patients sixty years of age or over. Whether or not emphysema, chronic Iung disease or a genera1 decrease in pulmonary function accounts for this is diffIcuIt to ascertain. When anaIyzing the complications one is impressed by the frequency of infectious processes which occurred postoperativeIy in fevers are inthese patients. If unexpIained cIuded as being due to some infectious process, 37 per cent of a11 the compIications were due to infection. This does not differ significantIy from the younger group of surgica1 patients. Finding that the morbidity and mortality rates in patients over sixty years of age are significantly higher than in those patients under sixty years of age certainIy suggests the necessity for further investigation into these probIems in the eIderIy patient. A rigid definition and cIass&cation of postoperative compIications is needed in a study of this type. With the heIp of vaIid statistics the exact incidence of postoperative compIications can be determined and technic appIied toward reducing the more common compIications in the eIderIy surgica1 patient.
COMPLICATIONS
Type of Complication
No. of Cases
Urinary infection. Uremia. Lower nephron nephrosis.. Hydronephrosis,
7 4 4 I
Total.............................
16
TABLE VI MISCELLANEOUS COMPLICATIONS
Type of Complication
No. of Cases
-I Unexplained
temperature
over
101.5’~.
Drug alIergy ........................ Psychosis ............................ .......................... Septicemia. Operative rupture of spleen ............ Other.. ...........................
TotaI.............................
34 2 2 2
./
i 47
unexpIained temperature of orally. (TabIe VI.) The others in&de a variety of conditions, occurred without any significant
101.5%. over in this group some of which frequency.
COMMENTS
This rather detaiIed examination of postoperative compIications which occurred after 532 major operations upon patients sixty years of age or oIder has shown severa interesting things. It was found that whereas the frequency of compIications in this group of patients is sign&antIy increased over those patients under sixty years of age, the eIderIy patient was not more prone to any particuIar type of compIication. In other words, the percentage of wound, gastrointestina1, puIcardiovascuIar and urinary commonary, pIications was approximateIy the same in patients under sixty years as it was in patients over sixty years of age. CompIications in the eIderIy maIe patient were more frequent than in the eIderIy femaIe patient. AIso, compIications were more frequent in service patients than in private patients. The higher percentage of poor-risk patients on the cIinica1 service probabIy ex-
SUMMARY I.
A
review
upon patients 716
of 723 operations performed sixty years of age or over on the
Postoperative
Complications
in the
EIderIy
SurgicaI
Patient
5. Extreme obesity (30 per cent or more above idea1 weight) was associated with a higher complication rate but moderateIy obese patients had no increase in complications. 6. Atelectasis was three times more common in elderly patients than in patients under sixty years of age. 7. The need is pointed out for more accurate recording of postoperative complications if proper steps are to be taken to reduce our current complication rate.
general surgical service showed that 523 were major operations, of which 35 per cent were folIowed by one or more postoperative complications. This compared to a 23 per cent comphcation rate in patients under sixty. .years of age for the same time period. The complication rate for minor surgery in the eIderly patients was I I per cent compared to 4 per cent in the younger patients. 2. The mortahty rate fohowing major surgery in the patients sixty years of age and over was 8.5 per cent compared to 4 per cent in the patients under sixty years of age. Pulmonary complications were the most frequentIy encountered type in those patients who died postoperatively. 3. More complications arose in the eIderIy maIe than in the elderly femaIe patient. 4. Wound and gastrointestinal comphcations were the most frequent encountered.
REFERENCES I. HACK, C. A. and DALE, W. A. Major
surgery in old people. Arch. .hrg., 64: 421, 1952. 2. LIMBOSCH, J. Experiences with more than 1,000 eIderIy surgical patients. Arch. Surg., 73: 124, 1956. 3. RANKIN, F. W. and JOHNSTON,C. C. Major operations in elderly patients, Surgery, 5: 763, 1939. 4. Unpublished data.
717