C. N. Ochoa Chaar1, L. A. Skrip3, J. E. Indes1, R. J. Gusberg2, T. P. Sarac1, A. Dardik2 1Yale University School Of Medicine,Department Of Surgery, Division Of Vascular Surgery,New Haven, CT, USA 2VA Connecticut Healthcare System,Department Of Surgery, Division Of Vascular Surgery,West Haven, CT, USA 3Yale School Of Public Health,Department Of Epidemiology And Microbial Diseases,New Haven, CT, USA
Introduction: Octogenarians (OCT) and nonagenarians (NON) are considered the “very old” and are often viewed as one group. Americans are aging, with the proportion of the very old expected to increase from 1.9% of the population to 4.3% in 2050. This study aims to underscore the differences in surgical trends, demographics and outcomes between OCT and NON.
Methods: The NSQIP data base (2007 – 2012) was used to derive the type of surgeries, demographics, comorbidities, and outcomes of OCT and NON undergoing non-emergent vascular, orthopedic, and general surgery procedures. Differences between OCT and NON were assessed using Chi-square tests or t-tests for categorical or continuous variables, respectively. Risk ratios with their 95% confidence intervals were calculated to evaluate linear trends over time in the percentages of surgeries performed in NON and OCT. Statistical analyses were conducted using R Statistical Software version 3.0.1 or SAS version 9.3.
Results: Between 2007 and 2012, NON accounted for a steadily increasing percentage of surgeries recorded in NSQIP (85 to 121 per 10,000 surgeries, RR = 1.42; 95% CI: 1.30 – 1.54). This change is consistent across the surgical specialties studied: vascular surgery (RR= 1.22; 95% CI: 1.15 – 1.30), general surgery (RR= 1.18; 95% CI: 1.07 – 1.30), and orthopedic surgery (RR = 2.35; 95% CI: 2.19 – 2.51). The percentage of OCT undergoing surgery remained unchanged during the same time period (RR = 1.02; 95% CI: 0.99 – 1.05). NON undergoing vascular surgery are more likely to be females (54.00% vs 41.16%, p<0.001) and less likely to live independently (68.49% vs 83.87%, p<0.001) compared to OCT. NON have a lower incidence of diabetes (15.05% vs 19.4%, p<0.001), smoking (3.41% vs 10.17%, p<0.001), and dialysis (3.77% vs 5.12%, p<0.001). OCT are more likely to previously have cardiac surgery (24.79% vs 16.43%, p<0.001) and previous percutaneous coronary interventions (16.87% vs 13.18%, p<0.001). There were significantly more patients with Do Not Resuscitate (DNR) order in NON (8.63% vs 2.29%, p<0.001) who underwent vascular surgery. NON have higher 30 day perioperative mortality (6.88% vs 3.4%, p<0.001), and longer hospital stay (4.97 ± 5.91 days vs 4.39 ± 6.20 days, p<0.001) than OCT after vascular surgery procedures. The same trends were found for NON undergoing orthopedic and general surgery procedures.
Conclusion: NON are a rapidly growing group of surgical patients with significantly higher perioperative mortality and longer postoperative hospital stay. The impact of surgery on the quality of life of NON needs to be studied to justify the increasing healthcare costs.