Background: As a result of rising life expectancy and low birth rates, elderly people make up an increasing proportion of the population of the United States. Studies estimate that by year 2050, the nonagenarian population will reach 8.7 million. Elderly people have significant medical care needs, and the increasing demand for surgical care in nonagenarians will require more nuanced evaluation of surgical candidates in this population.  

Methods: A retrospective analysis was performed through electronic medical record chart review to identify nonagenarians & centenarians who underwent acute care surgery over the last 5 years at Mount Sinai South Nassau (January 2015-December 2019). Demographic data (age, gender, comorbidities, ASA class) and surgical data (pre-operative and post-operative diagnosis, procedure performed, length of time of procedure, anesthesia administered) were found and compare to outcomes (length of stay, length of ICU stay, post-operative complications, disposition, mortality).

Results: A total of 106 patients over the age of 90 underwent 109 surgical procedures at our institution between 2015 and 2019. There was an age range of 90-101 and 60% women and 40% men. The most common procedure performed was cholecystectomy, followed by large bowel resection, small bowel resection, and groin hernia repair. 33% developed postoperative complications, while 82% survived to discharge. 

Conclusions: Although surgery is often avoided in elderly patients, especially those over the age of ninety, many of the patients in this population tolerate acute care surgery well, with a vast majority surviving to discharge. With appropriate discussion with the patient and their family on risks, benefits, and alternatives to surgery, it can be considered appropriate to proceed to the operating room.

ACUTE CARE SURGERY IN NONAGENARIANS AND CENTENARIANS

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