Surgical infection and the aging population

With the general aging of the United States population we can expect to enc ounter increasing numbers of elderly patients with surgical infections. To further delineate this population, patient attributes, treatment characteri stics, and outcomes were examined in elderly patients with surgical infecti on. All infections from December 1996 through May 2000 occurring on the inp atient, adult general, and trauma surgical services at a university hospita l were studied prospectively. Characteristics, comorbidities, and outcomes were examined in patients greater than or equal to 70 years of age and comp ared with those of patients <70 years of age. Elderly patients had signific antly higher Acute Physiology and Chronic Health Evaluation (APACHE) II sco res (15.4<plus/minus>0.3 vs 11.2 +/-0.2, P<0.001) and greater numbers of co morbidities than the younger population. The Acute Physiology score; infect ing organisms; and rates of pneumonia and intra-abdominal, central line, an d bloodstream infection were similar between groups. Crude mortality (21.7% vs 8.1%, P<0.001) and mortality associated with pneumonia (31.0% vs 17.2%, P=0.005), central venous catheter infection (50.0% vs 17.4%, P<0.001), blo odstream infection (32.3% vs 16.6%, P=0.006), and intra-abdominal infection (23.2% vs 6.3%, P<0.001) were significantly higher in the elderly. Logisti c regression analysis identified APACHE II score, cerebrovascular disease, and fungal infection as independent predictors of mortality in the elderly population. Surgical infection in the elderly is associated with a high mor tality and requires special consideration when treating this unique populat ion.