SURGERY IN THE AGED IN KOREA

Objective: To compare clinical characteristics, including postoperativ e outcomes, in Korean patients 65 years and older with those of younge r patients. Design: A retrospective medical record review. Setting: An adult university hospital. Participants: All patients who underwent v arious operative procedures, especially for stomach cancer, acute surg ical abdomen, and abdominal wall hernia, in the Department of Surgery at Seoul National University Hospital, Seoul, Korea, in 1994 and 1995. Main Outcome Measures: Demographics, disease pattern, length and exte nt of operation, hospital course including postoperative complications , and mortality. Results: A clear increase in the patients 65 years an d older was found. Of 2893 patients who underwent surgery in 1994, 735 were 40 years and younger (group 1), 1691 were 41 to 64 years old (gr oup 2), and 467 were 65 years and older (group 3). The most common dis ease was stomach cancer in all age groups, with the highest incidence in group 3. Emergency operations were performed most often in group 1 (P<.05; chi(2) test). Malignant neoplasm requiring a surgical procedur e was identified more frequently with age (P<.001). Among patients wit h acute surgical abdomen, acute appendicitis was the most common disea se in all age groups, whereas more serious diseases were found with ag e. In the analysis of stomach cancer, male patients increased with age (P<.001). Patients in group 3 had a poor preoperative physical status , and their perioperative courses were the most eventful among all gro ups (P<.05). However, no statistical differences among groups were pre sent for resectability, postoperative length of hospitalization, posto perative complication, and mortality. In the analysis of operations fo r acute surgical abdomen including acute appendicitis, with their unfa vorable preoperative physical status and eventful postoperative course s, perforation of the appendix and postoperative complications were mo st common in group 3 (P<.001). No statistical differences among groups were noted for operative mortality. In addition, in the analysis of a bdominal wall hernia, no statistical differences among groups were fou nd for postoperative complication and mortality. Conclusions: The prop ortion of patients 65 years and older among all surgical cases has inc reased in recent years. The proportion of malignant neoplasms, especia lly stomach cancer, was higher in the aged patients. Most operations w ere performed electively on the aged patients, as were these on younge r patients. In the case of the acute surgical abdomen, severe diseases with an underlying malignant neoplasm were more frequently found in t he aged patients. Despite their generally poor physical status, the pa tients 65 years and older proved to be able to tolerate elective major operations, such as radical gastrectomy for stomach cancer, when opti mal perioperative management was provided. However, results of emergen cy operations in these elderly patients were poorer, with a higher com plication rate. Therefore, the aged patient should be regarded as a ca ndidate for surgery but with a more careful and comprehensive approach to his or her treatment perioperatively.