Ageing acute surgical population: the Auckland experience

BackgroundThis study provides data supporting the supposition that more elderly patients are requiring surgical care and illustrates the risks associated with acute surgical illness in elderly patients. MethodsThe clinical records database was accessed to identify all patients discharged from general surgery and acute surgical unit (ASU) during 2013 and 2014. These groups were stratified by age (over 80years). Data were collected on number of patients discharged per year, length of stay, number of intensive care unit admissions and number of procedures and mortality rates. ResultsThere is an increasing number of patients aged over 80years who were discharged from ASU; 7.02% (n=296) in 2013 and 8.20% (n=344) in 2014. Patients aged over 80years were spending 1.88days (P-value<0.001) longer in hospital than those under 80years in 2014. Mortality rates in 2013 were 3.716 deaths per 100 admissions and 5.814 per 100 admissions in 2014. In 2013, the risk ratio of death in hospital for patients over 80years was 36.4 (P-value<0.001) times higher than patients under 80years. ConclusionThe mean length of stay and mortality rates are higher for patients over 80years. Mortality rates are higher in acute admissions compared with elective admissions. This identifies a need for increased care for elderly patients admitted for acute surgical care. We suggest a trial of attaching a specialist geriatrician to the ASU who will provide a service for at risk patients.