Surgical Risks for Elderly Outpatients

A study has found that the likelihood of an elderly patient being admitted to a hospital within seven days or dying shortly after undergoing surgery in an outpatient setting depends on the health characteristics of the patient and where the surgery was performed. The results were reported in the January 2004 issue of The Archives of Surgery.

About 60-70% of all U.S. surgical procedures are now performed in an outpatient setting, such as a doctor's office or a specialized surgery center. Researchers studied 564,267 surgical procedures, of which 360,780 were performed at a hospital-based outpatient center, 175,288 were performed at a free-standing ambulatory surgery center (ASCs), and 28,199 were performed in a doctor's office. On the day of surgery, no deaths occurred at a doctor's office, four deaths occurred at an ASC, and nine deaths occurred at an outpatient hospital. The seven-day death rate was 35 per 100,000 procedures at a doctor's office, 25 per 100,000 at an ASC, and 50 per 100,000 at a hospital-based outpatient center.

The researchers found that advanced age, prior inpatient hospitalization within the past six months, and invasiveness of the surgery performed were indicators of an increased risk of hospital admission or death within seven days of outpatient surgery.
"The accelerated pace at which more complex procedures are being performed in locations increasingly removed from sophisticated support facilities requires that this effort be structured to permit appropriate assessment of these trends,” write the authors, led by Lee A. Fleisher, M.D., of Johns Hopkins University (Baltimore, MD, USA). The authors also note that patients identified as high risk during preoperative evaluation should undergo surgery in locations with the best resources.




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