Increasing Proportion of Elderly Patients that make use of the Surgery Services of the UPR-affiliated Hospitals

Abstract

Objective: To evaluate how the proportion of elderly patients aged 65 and above has increased in our surgical services over a 5-year period. Methods: We compared the ages and characteristics of the surgical cases in 2014 with those in 2019, a 5-year interval, using the information from the University of Puerto Rico (UPR) General Surgery Database. The variables examined included age, gender, American Society of Anesthesiology (ASA) classification and outcome. Results: In the UPR General Surgery Database information was available for 4,906 surgical cases performed in 2014 and for 4,954 such cases performed in 2019. The mean age of the patients increased from 48 (±23) years to 50 (±22) years in the 5-year interval. The gender distribution indicated that 56% were women and 44% were men, with no significant difference between the 2 periods evaluated. A statistically significant (P<0.001) increase in patients, 65 years of age and older occurred from 2014 (27%) to 2019 (31%). Patients aged 65 years and older were sicker, as indicated by more frequent ASA classifications of 3 or greater (in 2014: 13% vs. 32% and in 2019: 31% vs. 59%; P<0.001). Postoperative morbidity and/or mortality were slightly higher in the older group (5%, 3%) when compared to the younger group (3%, 2%). Conclusion: Elderly patients represent about one-third of the surgical workload, a proportion that is expected to grow as the general population ages. The rapid aging of the population presents important challenges, such as shifting disease burden and increased expenditures on health and the long-term care of the elderly, for which we will have to prepare.