From the Guidelines
Age is a significant factor in healthcare and surgical outcomes, with older patients experiencing higher risks and complications, but frailty is now recognized as a better predictor of surgical outcomes than chronological age alone. Advanced age is associated with increased mortality, longer hospital stays, higher readmission rates, and more postoperative complications following surgery, as seen in a study of CABG procedures in patients over 70 years old, which reported operative mortality rates declining from 7.2% to 4.4% between 1982 and 1991, but with little further change thereafter 1. This occurs because aging brings physiological changes including decreased organ function, reduced physiologic reserve, impaired wound healing, and increased comorbidities like hypertension, diabetes, and heart disease.
Older patients often have altered medication metabolism, requiring dose adjustments and careful monitoring for drug interactions. A systematic review of perioperative clinical practice guidelines for care of older adults living with frailty found that high-quality and consistent recommendations supported preoperative, multidimensional frailty assessment, avoidance of urinary catheterisation, and multidisciplinary perioperative care and communication 1. Frail patients show 2-3 times higher complication rates regardless of age, highlighting the importance of preoperative assessment, including comprehensive geriatric evaluation, medication review, nutritional status assessment, and cognitive screening.
Optimizing outcomes requires multidisciplinary approaches including prehabilitation programs to improve functional capacity before surgery, careful anesthesia management, early mobilization, and tailored pain management strategies. Despite these challenges, age alone should not disqualify patients from necessary interventions, as many elderly patients benefit substantially from appropriate surgical procedures when properly selected and managed, as demonstrated by a study of PCI in patients over 65 years old, which reported an overall success rate of 93.5% and an immediate in-hospital mortality rate of 1.4% 1. A comprehensive geriatric evaluation and multidisciplinary approach to care can help optimize outcomes for older patients undergoing surgery.
From the FDA Drug Label
An effect of atorvastatin calcium was seen regardless of age, sex, or baseline lipid levels. The overall risk reduction was consistent regardless of age (<65, ≥65) or sex.
The association between age and healthcare or surgical outcomes is not directly related to a significant difference in the studied population.
- The primary analysis did not show any age-related differences in the effect of atorvastatin calcium on major cardiovascular events.
- The TNT study found that the overall risk reduction was consistent regardless of age (<65, ≥65) or sex 2. No conclusion can be drawn regarding the specific association between age and healthcare or surgical outcomes.
From the Research
Age Association with Healthcare and Surgical Outcomes
- The relationship between age and surgical outcomes is complex, with multiple factors influencing mortality rates in elderly patients, including physiologic changes, underlying disease states, and the type of procedure performed 3.
- Older adults who undergo emergency general surgery often view the decision to proceed with surgery as a choice between life and death, and they value prolonging their life, but may have limited participation in decision-making due to severe symptoms and time constraints 4.
- Increasing age is associated with higher complication rates and mortality in patients undergoing acute care surgery, even in the absence of comorbidities, with patients over 61 years old having a higher risk of mortality and those over 50 years old being at higher risk for postoperative complications 5.
- The surgical population is aging at a faster rate than the general population, with a growing number of people aged 75 years or older undergoing surgery, and this trend is expected to continue, with estimated costs of €3.2 billion by 2030 6.
- Age alone should not be used as a criterion to deny surgery to elderly patients, as many patients can benefit from surgical procedures despite their age 3.
- The impact of age on surgical outcomes can be influenced by various factors, including the patient's overall health, the type of procedure, and the presence of comorbidities, highlighting the need for individualized care and decision-making 3, 5.