Abdominal surgery in elderly patients: Statistical analysis of clinical factors prognostic of mortality in 1,000 cases

The high rates of abdominal disorders in a growing population of elderly patients and the greater willingness of the surgeon to cope with major problems in the elderly are factors contributing to a steady increase in abdominal procedures in this group. The decision-making process in surgery for elderly persons is of great importance, requiring consideration of ethical, medicolegal, and economic factors in addition to the purely medical ones. One thousand consecutive abdominal surgical procedures in patients over 70 years of age were submitted to computer analysis, to determine the principal factors affecting mortality and morbidity. A high percentage of the procedures related to the biliary tract; the second largest group was for intestinal obstruction, both benign and malignant. Analysis of data presented in this series leads to the following conclusions: (a) There is a declining mortality rate in elective operations in the elderly, in the absence of wide-spread malignancy. (b) The principal factors leading to high mortality in this series were age 80 and above, ASA category 3, inoperable malignancy, generalized peritonitis, and tumors of the pancreas. If two or more of these ominous factors are present, mortality above 50% is to be anticipated.