Advancing Age and 30-Day Adverse Outcomes After Nonemergent General Surgeries

Objectives To determine whether 30-day postoperative mortality, complications, failure-to-rescue (FTR) rates, and postoperative length of stay increase with advancing age. Design Retrospective cohort study. Setting Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. Participants Individuals undergoing nonemergent major general surgeries between 2005 and 2008 were studied (N = 165,600). Measurements Postoperative outcomes of interest were complications occurring within 30 days of the index operation, return to the operating room within 30 days, FTR after a postoperative complication, postsurgical length of stay, and 30-day mortality. Results Postoperative mortality, overall morbidity, and each type of postoperative complication increased with increasing age. Rates of FTR after each type of postoperative complication also increased with age. Mortality in individuals aged 80 and older after renal insufficiency (43.3%), stroke (36.5%), myocardial infarction (MI) (35.6%), and pulmonary complications (25-39%) were particularly high. Median postoperative length of stay increased with age after surgical site infection, urinary tract infection, pneumonia, return to the operating room, and overall morbidity but not after venous thromboembolism, stroke, MI, renal insufficiency, failure to wean from the ventilator, or reintubation. Conclusion Thirty-day mortality and complication and FTR rates increase with age after nonemergent general surgeries. Individuals aged 80 and older have especially high mortality after renal, cardiovascular, and pulmonary complications. Surgeons need to be more selective with advancing age regarding who will benefit from the surgical intervention.