The risk assessment of surgery for gastrointestinal cancer in patients of age 80 or over

Abstract

Background : We analyzed postoperative morbidity and mortality in patients of age 80 or over undergoing surgery for gastrointestinal cancer.
Patients and Methods : We enrolled 327 patients of age 80 or over operated an for gastrointestinal cancer between April 2003 and March 2009 at Ohta Nishinouchi General Hospital, to study contributing factors for 30 day-mortality and postoperative morbidity.
Results : The overall morbidity was 46% (151 patients) and the 30-day mortality was 6% (20 patients). Gender, serum sodium, albumin, urea, creatinine, intraoperative blood loss, intraoperative blood transfusion and emergency operation were defined as significant risk factors for morbidity. Logistic regression analysis demonstrated that intraoperative blood transfusion was one of the strongest independent risk factors (Odds ratio 2.4) of morbidity. On the other hand, four POSSUM items involving physiological score (PS), operative severity score (OS), predicted mortality rate and predicted morbidity rate had statistically significant correlations with surgical outcomes. When the high risk group about morbidity was designated as PS 24 or more, and OS 16 or more, the morbidity rate was 65% in the high risk group, which was significantly higher than that in the low risk group (30%).
Conclusion : Intraoperative blood transfusion is a significant risk factor for surgeries of gastrointestinal cancer in elderly patients. POSSUM scores are also useful as indicators for the risk assessment of surgery for gastrointestinal cancer.