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In the year following major surgery, more than 1 in 4 frail older persons and about 1 in 3 of them who had probable dementia died.
In a prospective longitudinal cohort trial, older frail people who had probable dementia were found to have higher mortality following major surgery, underlining the potential prognostic usefulness of geriatric disorders. The goal of Thomas M. Gill et al. was to estimate mortality following major surgery in older individuals and to analyze how these estimates varied depending on important geriatric, surgical, and demographic factors.
Subjects were community-living fee-for-service Medicare beneficiaries (n=5590), > 65 years of age, from National Health and Aging Trends Study (NHATS). Data from Centers for Medicare & Medicaid Services were linked to identify major surgeries and mortality over one year. The yearly NHATS evaluations were used to gather information on dementia and frailty.
For the 1193 major surgeries and 992 community-living volunteers, the mean (standard deviation [SD]) age was 79.2 (7.1) years. Overall, there were 198 non-Hispanic Black (16.6%); 30 Hispanics (2.5%); 665 women (55.7%), and 915 non-Hispanic White (76.7%). There were 206 fatalities throughout the 1-year follow-up period, representing 13.4% mortality and 872 096 survey-weighted deaths.
The mortality rate for elective surgery was 7.4%, whereas, for nonelective surgery, it was 22.3%. For geriatric subgroups, the 1-year death rate was 32.7% for those with probable dementia, 11.6% for those without dementia, 27.8% for frail individuals, and 6.0% for non-frail individuals. The age- and gender-adjusted hazard ratios for one-year mortality were 2.18 in the case of probable dementia with a restricted mean survival time reduction of 44.9 days and 4.41 in the case of frailty with a restricted mean survival time reduction of 48.8 days.
Population-based estimate of 1-year mortality following major surgery among community-living older individuals was 13.4%, although it was three times greater for nonelective compared to elective operations. Elderly people who were frail or had probable dementia had significantly higher mortality rates, underscoring the potential prognostic value of geriatric disorders following major surgery.
JAMA Surgery
Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults
Thomas M. Gill et al.
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