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Factors related to mortality in geriatric patients after elective surgery: a retrospective cohort study

Abstract

Introduction: The increased number of surgery on the elderly is often followed by an increased risk of mortality rate. Identifying the risk factors of surgical death in elderly patients will be mandatory before making a decision.  This study aimed to determine mortality-associated factors in older people who underwent inpatient elective surgery.  

Methods: This cohort retrospective study analyzed secondary data from the medical records of geriatric patients hospitalized at Dr. Kariadi Hospital Semarang in 2020.  Patients aged ≥ 60 years and who have undergone elective surgery were included. Patients with incomplete medical records, who had undergone outpatient surgery, more than one surgery, and emergency surgery, Covid-19, were excluded. A total of 382 patients met the criteria.  In this study, independent variables analyzed were age, sex, nutritional status based on body mass index, functional status by Barthel, marital status, residence status, number of comorbidities according to Charlson Comorbidity Index, albumin levels, electrocardiogram (ECG) abnormalities, surgery type, and American Society of Anesthesiologists (ASA) status. The dependent variable was in-hospital mortality. In the logistic regression analysis, we identified the five most significant variables to allow for the prediction of in-hospital mortality.

Results:  Residence status (p= 0.003), ECG (p= 0.001), comorbidity (p <0.0001), albumin status (p< 0.0001), and ASA status (p< 0.0001) were identified as factors that affect postoperative mortality after multivariate analysis.

Conclusion: In this study, mortality-associated factors were living alone, ECG abnormality, comorbidity > 2, hypoalbumin, and ASA > 2.

References

  1. Kinsella K, Phillips DR, Butz WP, Bentzen MP, Hokenson RF. Global Aging: The Challenge of Success Population Reference Bureau (PRB). Population Reference Bureau [Internet]. 2005;60(1):1–44. Available from: http://www.prb.org/pdf05/60.1globalaging.pdf
  2. Lai NMS. World population aging, 2019 : [Internet]. World population ageing 2019. 2019. 1–64 p. Available from: https://digitallibrary.un.org/record/3846855
  3. Nichani SS, Grant PJ MPN. Perioperative evaluation and management. In: Halter JB, Ouslander JG, Studenski S, High KP, Asthane S, Ritchie CS,et all eds, editor. Hazzard’s geriatric medicine and gerontology seventh ed. Seventh. New York; 2017. p. 570–84.
  4. Cook DJ. Geriatric anesthesia [Internet]. American Geriatric Society. 2008 [cited 2020 Feb 19]. p. 9–52. Available from: newfrontiers.americangeriatric.org/chapter/pdf/rasp_2.pdf
  5. Tang B, Green C, Yeoh AC, Husain F, Subramaniam A. Post-operative outcomes in older patients: a single-centre observational study. ANZ J Surg. 2018;88(5):421–7.
  6. Story DA, Leslie K, Myles PS, Fink M, Poustie SJ, Forbes A, et al. Complications and mortality in older surgical patients in Australia and New Zealand (the REASON study): A multicentre, prospective, observational study. Anaesthesia. 2010 Oct;65(10):1022–30.
  7. JC C. Approach to the geriatric patient. In: M WR, RS H, M GH, JM B, TB E, AS J, editors. Rosen’s emergency medicine:concepts and clinical practice . ninth edit. Philadelphia: Elsevier; 2018. p. 401–6.
  8. Peters MG, Bartlett EK, Roses RE, Kelz RR, Fraker DL, Karakousis GC. Age-Related Morbidity and Mortality with Cytoreductive Surgery. Ann Surg Oncol. 2015;22:898–904.
  9. Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: A systematic review and meta-analysis. Age Ageing. 2014;43(4):464–71.
  10. Pelavski AD, de Miguel M, Alcaraz Garcia-Tejedor G, Villarino L, Lacasta A, Señas L, et al. Mortality, Geriatric, and Nongeriatric Surgical Risk Factors among the Eldest Old: A Prospective Observational Study. Anesth Analg. 2017;125(4):1329–36.
  11. Atay IM, Aslan A, Burç H, Demirci D, Atay T. Is depression associated with functional recovery after hip fracture in the elderly? J Orthop. 2016;13(2):115–8.
  12. Choi JY, Yoon SJ, Kim SW, Jung HW, Kim K il, Kang E, et al. Prediction of Postoperative Complications Using Multidimensional Frailty Score in Older Female Cancer Patients with American Society of Anesthesiologists Physical Status Class 1 or 2. J Am Coll Surg [Internet]. 2015;221(3):652-660.e2. Available from: http://dx.doi.org/10.1016/j.jamcollsurg.2015.06.011
  13. Harris MJ, Brovman EY, Urman RD. Clinical predictors of postoperative delirium, functional status, and mortality in geriatric patients undergoing non-elective surgery for hip fracture. J Clin Anesth [Internet]. 2019;58(April):61–71. Available from: https://doi.org/10.1016/j.jclinane.2019.05.010
  14. Feng Z, Falkingham J, Liu X, Vlachantoni A. Changes in living arrangements and mortality among older people in China. SSM Popul Health [Internet]. 2017;3(November 2016):9–19. Available from: https://doi.org/10.1016/j.ssmph.2016.11.009
  15. BPS. Katalog: 4104001. Statistik Penduduk Lanjut Usia di Indonesia 2019. 2019. xxvi + 258 halaman.
  16. Robards J, Evandrou M, Falkingham J, Vlachantoni A. Mortality at older ages and moves in residential and sheltered housing: Evidence from the UK. J Epidemiol Community Health (1978). 2014;68(6):524–9.
  17. Matzen LE, Jepsen DB, Ryg J, Masud T. Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit. BMC Geriatr [Internet]. 2012;12(1):1. Available from: BMC Geriatrics
  18. Tarazona-Santabalbina FJ, Llabata-Broseta J, Belenguer-Varea Á, Álvarez-Martínez D, Cuesta-Peredo D, Avellana-Zaragoza JA. A daily multidisciplinary assessment of older adults undergoing elective colorectal cancer surgery is associated with reduced delirium and geriatric syndromes. J Geriatr Oncol [Internet]. 2019;10(2):298–303. Available from: https://doi.org/10.1016/j.jgo.2018.08.013
  19. Collin C, Wade DT, Davies S, Horne V. The barthel ADL index: A reliability study. Disabil Rehabil. 1988;10(2):61–3.
  20. Goldman A, Hod H, Chetrit A, Dankner R. Incidental abnormal ECG findings and long-term cardiovascular morbidity and all-cause mortality: A population based prospective study. Int J Cardiol [Internet]. 2019;295:36–41. Available from: https://doi.org/10.1016/j.ijcard.2019.08.015
  21. Rafiq A, Sklyar E, Bella JN. Cardiac Evaluation and Monitoring of Patients Undergoing Noncardiac Surgery. Health Serv Insights. 2017;10:117863291668607.
  22. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6–14.
  23. Fisher A, Fisher L, Srikusalanukul W, Smith PN. Usefulness of simple biomarkers at admission as independent indicators and predictors of in-hospital mortality in older hip fracture patients. Injury. 2018 Apr 1;49(4):829–40.
  24. van Stijn MFM, Korkic-Halilovic I, Bakker MSM, van der Ploeg T, van Leeuwen PAM, Houdijk APJ. Preoperative nutrition status and postoperative outcome in elderly general surgery patients: A systematic review. Vol. 37, Journal of Parenteral and Enteral Nutrition. 2013. p. 37–43.
  25. El-Haddawi F, Abu-Zidan F, Jones Wayne. FACTORS AFFECTING SURGICAL OUTCOME IN THE ELDERLY AT AUCKLAND HOSPITAL. Vol. 72, ANZ J. Surg. 2002.
  26. Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA. Multimorbidity and mortality in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr [Internet]. 2016;67:130–8. Available from: http://dx.doi.org/10.1016/j.archger.2016.07.008
  27. Lubben J, Blozik E, Gillmann G, Iliffe S, von Kruse WR, Beck JC, et al. Performance of an abbreviated version of the lubben social network scale among three European community-dwelling older adult populations. Gerontologist. 2006;46(4):503–13.
  28. Akirov A, Masri-Iraqi H, Atamna A, Shimon I. Low Albumin Levels Are Associated with Mortality Risk in Hospitalized Patients. American Journal of Medicine [Internet]. 2017;130(12):1465.e11-1465.e19. Available from: https://doi.org/10.1016/j.amjmed.2017.07.020
  29. Audisio RA. Preoperative Assessment of Surgical Risk in Oncogeriatric Patients. Oncologist [Internet]. 2005;10(4):262–8. Available from: http://theoncologist.alphamedpress.org/cgi/doi/10.1634/theoncologist.10-4-262
  30. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. ACC / AHA Clinical Practice Guideline 2014 ACC / AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery A Report of the American College of Cardiology / American Heart Association Task Force on Pr. 2014. 278–333 p.

How to Cite

Mupangati, Y. M., Mustain, Setyawan, H., Riwanto, I., Soejono, C. H., & Gasem, M. H. (2023). Factors related to mortality in geriatric patients after elective surgery: a retrospective cohort study. Bali Medical Journal, 12(1), 495–500. https://doi.org/10.15562/bmj.v12i1.4005

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