Clinical Analysis of Surgical Geriatric Patients over 65 Years of Age

Lee, Han Sang; Lee, Sun Yeong; Lee, Seong Yeol

Abstract

As the span of life is prolonged by socioeconomic and medical development, the percentage of the geriatric population is increasing annually. Now, surgical therapy for the geriatric patients is an important area of medicine. To understand the clinical significance of surgical geriatric patients, an analysis was made of the records at the Surgical Department of City hospital, East Seoul, for 182 patients over 65 years of age, who were treated from January 1990 through December 1995. The results are as follows: 1) The number of surgical patients admitted during the 6 years was 2,734, and the number of surgical geriatric patients admitted during the same period was 257 patients (9.4% of all surgical patients). The percentage of geriatric patients show an increasing tendency from 8.1% in 1994 to 11.3% in 1995. 2) The sex distribution was 140 male patients (54.5%) and 117 female patients (45.3%), a ratio of 1 : 0.83. 3) The average duration of admission was 18.2 days and durations of admission of less than 1 week were most common (21.8% of all geriatric admissions). 4) Of the 182 cases treated surgically, 139 cases (76.4%) involved general anesthesia, 32 cases (17.6%) anesthesia administered spinally, and 11 cases (60%) local anesthesia; One hour or less of general anesthetic time was most common (41.7%). 5) Malignant disease was found in 46 patients (25.3%); stomach cancer was the most frequently found malignant disease. Non-malignant disese was found in 136 patients (74.7%); appendicitis was the most frequently found non-malignant disease. 6) Coexistent disease was noticed in 108 patients (59.3%); cardiovascular disease was the most frequently found (27.1%), and chronic pulmonary disease (21.3%) and hypoproteinemia (14.2%) were next. 7) Operations were performed on 182 patients of the total 257 patients, operation rate of 70.8%. The old age group had a low operation rate. 8) Postoperative complications were occurred in 43 cases (23.6%), and operative mortality was 2.7%. The significant factors affecting postoperative morbidity and mortality were malignancy, long duration for the general anesthetic time, coexistent disease, and emergency operation. The results suggest that the number and the rate of surgical geriatric patients have increased and that age has little effect on the postoperative prognosis. Thus, we believe that more active preoperative treatment, complete therapy for coexistent disease, execution of elective surgery and a short anesthetic time for intentional surgery are important factors for decreasing postoperative morbidity and mortality for surgical geriatric patients.