Surgical disorders and treatment outcomes in elderly patients at Moi Teaching and Referral Hospital

Abstract

Background: The United Nations refers to older people as anyone above 60 years. Due to increase in life expectancy the world over, the elderly population is on the rise. This age group is greatly affected by social, economic and health challenges and have a higher morbidity and mortality rates. They also have a higher rate per population of undergoing surgical operation but our local statistics are unknown. Objective: To determine the surgical disorders and treatment outcomes among elderly patients at Moi Teaching and Referral Hospital. Methods: This was a cross sectional study that included patients aged 60 years and above who underwent major surgery at MTRH between December 2015 and September 2016. Using a consecutive sampling technique, data was collected on the social demographics, surgical conditions, comorbidity surgical intervention and clinical progress and outcome. Data analysis was done using R: A language and environment for statistical computing. Association between variables was done using Pearson’s Chi Square test. Results: The study included a total of 367 participants aged 60 to 94 years. The median age was 66.0 (IQR: 61.0, 71.0) years. The male to female ratio was 1.2:1. Majority (99.7%) were from a rural residence and 95.6% were married. Most had little or no formal education (93.4%). Majority were farmers (89.4%). The median monthly income was Ksh 7000 with 62.1% of the participants depending on relatives to settle their hospital bills. Malignancies accounted for most of the surgical operations (43.9%) followed by intracranial hematomas (13.1%) and abdominal surgical conditions (10.6%). Hypertension was the most common comorbidity at 11.7%. Other comorbidities included diabetes (6%) and HIV (1.1%) among others. The main surgeries conducted were gastrointestinal (27.5%) and genitourinary (27.2%) surgeries. Neurosurgery and orthopedic surgeries were conducted on 15.8%, and 8.2% of the participants respectively. Neck and spine surgeries accounted for 14.7% of all the surgeries done. Up to 15.3% of the patients had post-operative complications. Of those with complications, 39.3% had surgical site infections, and 16.1% had wound dehiscence, 12.5% had bleeding while 2.7% of the participants died after operation. The findings showed no correlation between the age group and either the presence of comorbidities (p = 0.054) or post-operative complications (p = 0.292). Conclusions: A significant proportion of elderly surgical patients are undergoing surgical operations due to malignancies and neurosurgical emergencies. Postoperative morbidity and mortality is, however, low. The noted comorbidities include hypertension, diabetes and HIV while the most common postoperative complication is surgical site infection. Recommendations: Management of the elderly surgical patient requires both the physician and the surgeon. HIV needs to be recognized as an emerging comorbidity amongst this age group. Elderly patients who need surgery should not be excluded from surgical procedures on the basis of their age.