Patients older than 80 years have been found to do well after noncardiac surgery, with surprisingly few complications, according to a study from Japan. However, there are several factors that predict postoperative adverse events, including preoperative hypoalbuminemia, intraoperative blood transfusion, longer operative time and male gender.
“The average life span has been rapidly increasing around the world,” commented Yoshinori Muto, MD, a senior resident at the University of Tokyo Hospital, in Japan. “Meanwhile, the volume of surgery for the elderly has also increased. As such, the aim of this study was to investigate the perioperative risk factors that predict 30-day postoperative complications in elderly patients who undergo noncardiac surgery.”
Dr. Muto and his colleagues identified 334 patients at least 80 years of age, who underwent noncardiac surgery under general anesthesia at his institution between January and December 2013. Several preoperative and intraoperative variables were recorded, including demographic data, anesthetic management, type of surgery, and preoperative comorbidities using the Charlson Comorbidity Index (CCI) score. The primary composite outcome was 30-day postoperative complications, including death, cardiac adverse events (heart failure, ischemic heart disease or atrial fibrillation), pneumonia and other infections, cerebrovascular disease and deep venous thrombosis/pulmonary embolism.
The 334 patients had a mean age of 82.9 years; slightly more than half (51.2%) were men. Abdominal surgery was performed in 121 patients (36.2%). “The most common comorbidity we found was moderate or severe renal disease, followed by tumor without metastasis,” Dr. Muto said in an interview with Anesthesiology News. The mean CCI score was 3.6, he added.
As Dr. Muto 30-day postoperative complications occurred in 91 patients (27.2%), including one death. Multiple logistic regression analysis revealed that four factors were associated with the development of postoperative complications: preoperative serum albumin concentration <3.5 g/mL (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.53-4.61; P<0.001); intraoperative blood transfusion (OR, 4.45; 95% CI, 1.96-10.10; P<0.001); operative time ≥120 minutes (OR, 3.11; 95% CI, 1.68-5.74; P<0.001) and male gender (OR, 1.97; 95% CI, 1.15-3.37; P=0.014).
“We found it surprising that hypoalbuminemia was a predicting factor for postoperative complications, whereas age and Charlson Comorbidity score were not, because there are so many reports that preoperative performance status is a predicting factor,” Dr. Muto said. “This may mean that nutritional condition was more important in the acute postoperative phase in elderly patients than age or preoperative comorbidities.
“Secondly, transfusion during surgery and longer operation time were identified as predicting factors,” he added. “This indicates that operative stress that requires intraoperative transfusion is more important than preoperative anemia. These results may help predict postoperative outcomes, but further research is also required to evaluate other factors.”