Frailty and dementia appear to have an outsized effect on one-year mortality after major surgery, a first-of-its-kind study reveals. The results highlight the importance of geriatric conditions as a factor in surgical prognosis, the researchers say.
Investigators from Yale University analyzed outcomes following 1,193 major surgeries in 992 U.S. community-living participants aged 65 years and older. The overall one-year mortality was 13%, but more than 1 in 4 frail patients and approximately 1 of 3 with probable dementia died in the year after their surgeries.
In addition, mortality was threefold higher for nonelective versus elective surgeries, and was especially elevated for patients aged 90 years and older, reported Robert D. Becher, MD, MS.
Recognizing geriatric risk
The study represented a wide array of surgery types and is the first — to the researchers’ knowledge — to evaluate validated measures of geriatric-specific conditions such as frailty or dementia, they reported. The results underscore the importance of taking common medical conditions faced by older adults into consideration when considering major surgery.
“Our findings define the scope and scale of mortality after major geriatric surgery in the U.S.,” said the study’s lead author, Thomas M. Gill, MD. “They suggest a mixed landscape of surgical quality and safety among older persons.”
Surgery common in elders
Major surgery is common among community-living older adults, the authors noted.
“The five-year cumulative risk of major surgery is 13.8%, representing nearly 5 million older persons in the U.S.,” they wrote. This includes 12% among people aged 85 to 89 years old, 9% in those aged 90 years or older, 12% in those with frailty and 12% in those with probable dementia.
Full findings were published in JAMA Surgery.
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