Prospective Study on the Factors Influencing the Clinical Outcome of Various Laparoscopic Surgeries in Elderly Patients
Background: Laparoscopic techniques with its advantages of decreased wound complications, post-operative ileus, intraoperative blood loss, and reduced need for post-operative rehabilitation are gradually replacing many common surgical procedures that are performed in an increasingly aging population. The proportion of elderly people (age 60 years and above) is on the rise in India over the past few decades. However, elderly population has decreased cardiopulmonary reserve, carries a long list of medical comorbidities and prior surgical history. The safety and efficacy of laparoscopic surgeries in elderly population have been from studies conducted in Western population where the average life expectancy at present exceeds India.
Materials and Methods: Elderly patients at the Department of General Surgery at Saveetha Medical College and Hospital, Chennai, and Southern Railway Headquarters Hospital, Chennai, who are undergoing various laparoscopic surgeries are recruited and prospectively operated by the hospital protocol and perioperative pulmonary rehabilitation given and followed up till 1 month period postoperatively. The data are collected and the relevant statistical analysis done.
Results: There are 25 patients with Grade 2 and above complications. There are 18% surgical complications (Grade 2 and above); 19% medical complications (Grade 2 and above); and 10% combined (Grade 2 and above); in the total study population (n = 100). The overall mortality rate was 2% in this study population. In patients with Grade 2 and above, post-operative complications, using multivariate logistic regression (r2 = 0.65, significance F = 0.011) Charlson comorbidity score >2 (P = 0.02); the type of surgery (P = 0.02); and polypharmacy (P = 0.03), are found to have a statistically significant linear relationship. Whereas the chronological age (P = 0.09); sex (P = 0.10); the duration of surgery (P = 0.18); and the operating surgeon (P = 0.23) are statistically insignificant. The length of hospital stay was linearly associated with the type of surgery performed and high Charlson comorbidity score. Modified Barthel Index deterioration was associated with the type of surgery. The average pain score was 2. There was a reduction in the occurrence of post-operative pulmonary complications by about 84.37% in the population “at high risk” (PPC prediction score >3) with the routine use of perioperative pulmonary rehabilitation using incentive spirometry.
Conclusion: Laparoscopic surgery is safe in carefully selected subset of elderly population. Pre-operative stabilization of the comorbid condition should be done when feasible. Psychological counseling for the patient and the caretaker with emphasis on perioperative pulmonary rehabilitation and post-operative lifestyle modification should be done at the time of first consult. Further large-scale studies are needed to support these findings.
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