Perioperative morbidity and mortality in 80 years and older undergoing elective urology surgery – A prospective study

Figures & data

Table I.  The extent of operation.

Major surgery	Nephrectomy
	Percutanous nephrolithotripsy (PCNL)
	Bladder augmentation
	Urinary diversion
Intermediate procedure	Retropubic prostatectomy (RPP)
	Diverticulectomy
	Transurethral prostatectomy (TURP)
Minor surgery	Transurethral resection of bladder tumour
	Internal urethrotomy
	Cystoscopy with/without biopsy
	Hydrocele repair
	Orchiectomy
	Extra-corporeal shock wave lithotripsy (ESWL)

Table II.  Comparison of patients and surgery parameters of the study groups.

Parameter	≥80 years median (range)	<80 years median (range)	P value
Number	47	80
Age (years)	82 (80–95)	59 (19–75)	P < 0.001
Male/female	34/13	51/29	NS
ASA classification	3 (1–4)	2 (1–3)	P < 0.001
Presence of IHD	22 (46.8%)	11 (13.7%)	P < 0.001
Presence of DM	11 (23.4%)	18 (22.5%)	NS
Presence of HTN	39 (82.9%)	40 (50%)	P < 0.001
Presence of PD	11 (23.4%)	8 (10%)	NS
No. of medications	4 (0–12)	1.5 (0–6)	P < 0.001
Extent of operation
Minor	32 (68%)	65 (81.2%)	NS
Intermediate	9 (19.1%)	5 (6.2%)	NS
Major	6 (12.8%)	10 (12.5%)	NS
Type of anaesthesia
Local	3 (6.4%)	1 (1.2%)	NS
Regional	37 (78.7%)	58 (72.5%)	NS
General	1 (2.1%)	13 (16.2%)	P = 0.0031
Combined	6 (12.8%)	8 (10%)	NS
Duration of surgery (min)	45 (10–300)	45 (15–200)	NS
Intra-operative complications	3 (6.4%)	3 (3.7%)	P = 0.007
Immediate post-operative complications	10 (21.3%)	11 (13.7%)	NS
Post-discharge complications	7 (14.9%)	10 (12.5%)	NS
Mortality	1 (2.1%)	0	NS
Duration of hospitalization (days)	3 (1–50)	1 (1–15)	P < 0.001

NS, not significant; IHD, ischaemic heart disease; DM, diabetes mellitus; HTN, hypertension; PD, pulmonary disease.

Table III.  Comparison of patients who underwent major surgery.

Parameter	≥80 years median (range)	<80 years median (range)	P value
Number	6	10
Age (years)	81.5 (80–84)	50.5 (22–69)	P < 0.001
Male/female	3/3	2/8	NS
ASA classification	2 (2–3)	2 (1–3)	NS
Presence of IHD	0 (0%)	0 (0%)	NS
Presence of DM	1 (16.6%)	3 (33.3%)	NS
Presence of HTN	4 (75%)	5 (50%)	NS
Presence of PD	3 (50%)	2 (20%)	NS
No. of medications	2 (0–6)	2 (0–6)	NS
Type of anaesthesia
General	0 (0%)	2 (20%)	NS
Combined	6 (100%)	8 (80%)	NS
Duration of operation (min)	147 (60–300)	147 (120–200)	NS
Intra-operative complications	1 (16.6%)	2 (20%)	NS
Immediate post-operative complications	3 (50%)	3 (33.3%)	NS
Post-discharge complications	0 (0%)	0 (0%)	NS
Mortality	0 (0%)	0 (0%)	NS
Duration of hospitalization (days)	8 (5–21)	8 (4–15)	NS

NS, not significant; IHD, ischaemic heart disease; DM, diabetes mellitus; HTN, hypertension; PD, pulmonary disease.

Table IV.  Comparison of patients who underwent intermediate surgery.

Parameter	≥80 years median (range)	<80 years median (range)	P value
Number	9	5
Age (years)	83 (80–87)	74 (66–77)	P = 0.003
Male/female	8/1	5/0	NS
ASA classification	3 (1–4)	2 (1–4)	NS
Presence of IHD	4 (44.4%)	1 (20%)	NS
Presence of DM	1 (11.1%)	1 (20%)	NS
Presence of HTN	5 (55.5%)	1 (20%)	NS
Presence of PD	1 (11.1%)	0 (0%)	NS
No. of medications	2 (0–9)	2 (0–8)	NS
Type of anaesthesia
Regional	9 (100%)	4 (80%)	NS
General	0 (0%)	1 (20%)	NS
Duration of operation (min)	135 (60–220)	70 (60–90)	NS
Intra-operative complications	2 (22.2%)	1 (20%)	NS
Immediate post-operative complications	4 (44.4%)	2 (40%)	NS
Post-discharge complications	1 (11.1%)	0 (0%)	NS
Mortality	0 (0%)	0 (0%)	NS
Duration of hospitalization (days)	5 (3–50)	4 (2–7)	NS

NS, not significant; IHD, ischaemic heart disease; DM, diabetes mellitus; HTN, hypertension; PD, pulmonary disease.

Table V.  Comparison of patients who underwent minor operation.

Parameter	≥80 years median (range)	<80 years median (range)	P value
Number	32	65
Age (years)	82.5 (80–95)	59 (19–79)	P < 0.001
Male/female	23/9	44/21	NS
ASA classification	2.5 (2–3)	2 (1–3)	P = 0.001
Presence of IHD	18 (56.3%)	9 (13.8%)	P < 0.001
Presence of DM	9 (28.1%)	14 (21.5%)	NS
Presence of HTN	30 (93.8%)	33 (50.7%)	P < 0.001
Presence of PD	6 (18.8%)	6 (9.2%)	NS
No. of medications	5 (0–12)	1 (0–11)	P < 0.001
Type of anaesthesia
Local	3 (9.4%)	1 (1.5%)	NS
Regional	28 (87.5%)	54 (83.1%)	NS
General	1 (3.1%)	10 (15.4%)	NS
Duration of operation (min)	45 (10–135)	45 (15–120)	P < 0.001
Intra-operative complications	0 (0%)	0 (0%)	NS
Immediate post-operative complications	3 (9.4%)	6 (9.2%)	NS
Post-discharge complications	7 (21.8%)	10 (15.4%)	NS
Mortality	1 (3.1%)	0 (0%)	NS
Duration of hospitalization (days)	3 (1–9)	1 (1–6)	P < 0.001

NS, not significant; IHD, ischaemic heart disease; DM, diabetes mellitus; HTN, hypertension; PD, pulmonary disease.