PHYSIOLOGICAL AGE AS AN OUTCOME PREDICTOR FOR ABDOMINAL-SURGERY IN ELDERLY PATIENTS

It would seem that a large discrepancy exists between the ''chronologi cal'' age and ''apparent'' age of elderly patients, and we often obser ve that the latter reflects the results of surgical procedures very we ft. In the present study, we reviewed 258 patients aged 70 years or ol der who underwent elective abdominal operations under general anesthes ia, to evaluate an outcome predictor representing their ''physiologica l'' age. A total of 24 preoperative variables were compared between pa tients who left the hospital in a satisfactory condition, being surviv ors, and those who died in hospital despite the operative procedure pe rformed, being nonsurvivors. In the group of patients aged between 70 and 79 years, there was no significant difference between the survivor and nonsurvivor groups for any of the variables examined; however, in the group of patients aged over 80 years old, the oldest of whom was 93 years, there were significant differences in the total lymphocyte c ount (TLC) and the performance status (PS), as well as in age, between the survivor and nonsurvivor groups. Utilizing the three variables of age, PS, acid TLC, a computer-generated discriminant function analysi s yielded an equation which discriminated survival with 97% accuracy, and mortality with 83% accuracy. These findings indicate that the PS a nd TLC scores added to the chronological age should be considered when deciding whether a surgical procedure is appropriate for an elderly p atient.