dc.description.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. |
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