Patients aged 80 and over are significantly less likely to be investigated or aggressively treated after surgery than those in younger age groups, according to an audit of hospital deaths in Australia.
This is in spite of the fact that the oldest patients have higher rates of trauma and multiple underlying conditions on admission, noted researchers in the online journal BMJ Open.
“There may be a culture of less intensive investigation, monitoring and possible failure to intervene in the elderly group”
The researchers assessed data from a national audit of deaths after surgical procedures in every specialty carried out from 2009-12 in 111 public and 61 private hospitals across Australia.
Over 11,000 patients were included in the final analysis. This group was divided into three age bands: 17-64, 65-79 and those aged 80 and above. The average age of those who died soon after a surgical procedure was 78.
Of those who died in hospital, most had been admitted as emergencies (83.4%). Nearly half (45%) had an incapacitating and life threatening disease on admission.
The oldest old had higher rates of admission as a result of trauma or other emergency than either of the two other age groups. But they were treated differently, receiving lower levels of aggressive and expensive treatment, said the study authors.
They had around half the rate (11%) of unplanned returns to theatre of those aged 65-79 (20%). They were also less likely to have unplanned admissions to intensive care (16% versus 24%) and less likely to be treated in intensive care (60% versus 77%).
Surgical care for older patients tends to be complex, which is likely to influence decisions about their hospital care, noted the researchers.
Nonetheless, they said the oldest old had the lowest rate of diagnosed post-operative complications, despite virtually all of them having multiple underlying conditions that are usually associated with a higher risk of problems arising after surgery.
The study authors said: “Our data suggest that there may be a culture of less intensive investigation, monitoring and possible failure to intervene in the elderly group.”