Safety of urologic surgical intervention in the elderly

Abstract

Concomitant with the rapidly increasing elderly population in the United States is the development and manifestation of urologic diseases. Besides diagnosing urologic diseases in the geriatric population, the urologic surgeon must be prepared to treat this population. To determine if urologic surgical intervention is safe in this patient population, the records of 59 patients who underwent major urological procedures with anesthesia were reviewed. The mean age was 84.6 years (range 80–101), 55 (92.2%) were males and 4 (6.8%) were females. The patients were divided according to the American Society of Anesthesiologists (ASA) guidelines. In this study 57.6% of the patients had at least one severe, non-incapacitating, systemic disease which constituted an ASA classification of 3 and above. Forty one patients (69.5%) had endoscopic procedures; transurethral resection of the prostate made up the majority of these, 25 (61%). Eighteen patients (30.5%) underwent open procedures; the majority of these (11 of 18) consisted of abdominal and pelvic surgery: radical cystectomy (3), radical nephrectomy (3), suprapubic prostatectomy (3), suprapubic exploration and pelvic lymph node dissection [1], and ileal ureter interposition with bladder cap augmentation (1). The remaining seven patients had scrotal procedures. There were no deaths in either group. Complications occurred in five patients (8.5%); four of these patients had an ASA classification of 3 and above with 2/5 having cerebrovascular accidents. We concluded that age should not be the limiting factor in a decision to perform urologic procedures. Given the advancing age of the American population, surgery, both major endoscopic and open, may be performed in the geriatric population with minimum deaths and complications. Special care and perioperative monitoring should be provided in patients with ASA levels of 3 or greater.