Impact of age on in-hospital mortality of surgical patients in a German university hospital

Although the frequency of major surgical procedures in elderly patients is increasing, the impact of age as an independent factor on in-hospital mortality and capacity planning is uncertain. Therefore, we analyzed how age, gender, number of diagnoses, and number of operations per patient are reflecting the demographic changes going on in the last decade. Furthermore, we analyzed the influence of age, main diagnoses, and comorbidities on in-hospital mortality, and cost factors, like duration of in-hospital stay, number of operations, and stay at the intensive care unit using multiple regression analysis. One thousand four hundred and sixty-nine patients hospitalized in 1990, and 5718 patients hospitalized during 1998-2000 at the surgical department of a German university hospital were recruited. The average age of the patients increased significantly from the year 1990 to 1999 (by 4 years). The overall in-hospital mortality of the elderly patients (above 70 years of age) declined from 18.6% in 1990 to 7.6% in 2000. The number of diagnoses increased from 1.27 to 3.5 per patient. Age is a significant, independent risk factor for in-hospital mortality (odd's ratio (OR), 2.2), prolonged stay at intensive care unit (OR, 1.8), reoperation (OR, 1.3), and prolonged hospitalization (OR, 1.8). Nevertheless, oncologic diseases and pre-existing comorbidities are also significant independent factors for the clinical course and costs resulting from treating elderly patients. We conclude that decisions for surgical treatment should not be solely based on patient's age. The demographic changes in Europe result in an over-proportional increase in expenditures, which should be included when planning the capacities of a surgical department.