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How to Improve GI Surgery Mortality in the Elderly Studied

Patients older than 75 show markedly higher morbidity, mortality than younger patients

MONDAY, Nov. 23 (HealthDay News) -- Patients older than 75 years who undergo major gastrointestinal tract surgery have substantially higher morbidity -- including pulmonary and urologic complications -- and mortality than younger patients, according to research published in the November issue of the Archives of Surgery.

David J. Bentrem, M.D., of Northwestern University in Chicago, and colleagues analyzed data from the American College of Surgeons' National Surgical Quality Improvement Program on nearly 25,000 patients who underwent upper gastrointestinal, hepatobiliary, pancreatic, or colorectal surgeries.

The researchers found that elderly patients -- those over the age of 75 -- had 1.2 to two times higher overall perioperative morbidity than younger patients, as well as 2.9 to 6.7 times higher mortality after adjustment for preoperative comorbidity. The elderly were more likely to have pulmonary complications, such as pneumonia, at rates up to 5.1 times higher. They were also more likely to have urologic complications, such as urinary tract infection, at rates up to 6.8 times higher. Cardiac complications, such as acute myocardial infarction, were up to 18 times higher in elderly patients.

"Current quality measures for the elderly (such as Medicare's Surgical Care Improvement Program) address only myocardial infarction, surgical site infection, and deep venous thrombosis. Our data reveal targets and opportunities for improving care for elderly patients. If care for the elderly is to be improved, quality improvement initiatives need to be expanded to include pulmonary and urologic complications," the authors conclude.

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