Surgery In Geriatric Patients Research Articles

The effectiveness of the Raja Isteri Pengiran Anak Saleha Appendicitis Score in the diagnosis of acute appendicitis in elderly patients

Acute appendicitis (AA) is the most common cause of acute abdominal surgeries, accounting for 15% of all emergency visits due to acute abdominal pain in patients aged over 60 years. Appendicitis is reported as the third most common cause of abdominal surgery in geriatric patients. In this current retrospective study, the records of 68 patients aged over 65 years, who were treated by surgical resection in our clinic diagnosed for AA between February 2015 and February 2020, were analyzed. The age, gender, duration of hospital stay of the patients and, histopathological results of appendectomy specimens were recorded. The Raja Isteri Pengrian Anak Saleha Appendicitis (RIPASA) Score of the patients was calculated according to the clinical history, physical examination, and laboratory parameters of the patients. According to the RIPASA scores, the patients were divided into three groups as the low-score group (4 to 7), the intermediate-score group (7.5 to 11.5), and the high-score group (≥ 12). The groups were compared on the basis of the microscopic diagnosis. According to the calculated RIPASA score, there were 12 patients in the low-score group, 44 patients in the intermediate-score group, and 12 patients in the high-score group. When the results were classified based on the pathology, we detected non-complicated conditions such as a normal appendix or reactive lymphoid hyperplasia in ten patients and catarrhal stage appendicitis in 38 patients along with complicated (gangrenous or perforated) appendicitis in 20 patients. In conclusion, the RIPASA score can be used in elderly patients considering its high accuracy rate. In elderly patients with a high RIPASA score, the pathological stage of the appendectomy specimen may also be complicated (perforated or gangrenous) appendicitis. Therefore, the mortality and morbidity rates may increase with increased complication rates.

The use of focused, radioguided parathyroidectomy in geriatric patients with a history of thyroid surgery.

Geriatric patients are often reluctant to undergo parathyroid surgery under general anesthesia because of the major comorbidities. The use of minimally invasive techniques for parathyroid lesions under local anesthesia have been published. Radioguided lesion localization has been known to decrease operative time and reduce the occurrence of positive margins in breast cancer surgery. We hypothesize that it could also be effectively used in focused parathyroid surgery in geriatric patients with in history of thyroid surgery. Our study group consists of geriatric patients with a history of thyroid surgery who underwent focused parathyroid surgery between February 2017 and October 2019. Group-1 included 18 patients who had parathyroidectomy under radioguidance. Group-2, 22 patients who had surgery without it. Patient demographics, operative time, number of frozen sections and length of hospital stay were analyzed. Analyzed data were similar between groups. The mean age of the patients was 72.56±12.65 years (range: 65-88). The operative times for group-1 and group-2, were 65.42±7.78 and 74.63±15.98 minutes, respectively (P=0.002). All patients were discharged uneventfully on postoperative day-2. Radioguidance parathyroidectomy positively affected the operative time and also decreased the need for additional frozen section.

Introduction. Cranial surgery in geriatric patients.

Introduction. Cranial surgery in geriatric patients.

Outcomes of Endoscopic Sinus Surgery in Geriatric Patients: An Institutional Study.

The aim of this study was to investigate the efficacy and safety of Endoscopic Sinus Surgery (ESS) as a treatment modality for chronic rhinosinusitis refractory to maximal medical therapy in the elderly population. ESS has gained importance over the past 2-3 decades. A prospective review of outcome was done in fifty seven patients over age of 60years who underwent ESS. They were evaluated preoperatively and postoperatively at 3, 6, and 12months with a rigid nasal endoscopy scoring system, and the Sino Nasal Outcome Test-20 questionnaire. Data analysis was performed using the Student's t test to compare mean scores. All complications were noted. All of the patients in the study reported postoperative symptomatic improvement. And it was concluded that ESS in the geriatric population is a safe and effective treatment modality for rhinosinusitis which is refractory to medical therapy.

How to Improve Outcomes of Spine Surgery in Geriatric Patients

The incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery. A literature search of the last 10 years was done. Outcomes of spine surgery using decompressive techniques only are similar to outcomes in younger patients. However, in patients with comorbidities, the outcomes are less favorable with more complications. Complication rates decrease when minimally invasive techniques are used. If a fusion surgery is necessary, especially in cases with deformity correction, complication rates significantly increase up to 60%. Osteoporosis comanagement is necessary to prevent nonunion and implant failure if a fusion surgery is planned. Enhanced recovery after surgery protocols can be an aid to preparation and rehabilitation of elderly patients. A frailty index can help to predict patients with the worst outcomes. Additional psychological support and some other measures will help to reduce the incidence of postoperative delirium. Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.

Safety and efficacy of retrograde intrarenal surgery in geriatric patients by age groups.

To evaluate the effects of aging on the success rate of retrograde intrarenal surgery (RIRS) and the development of medical and surgical complications by dividing geriatric patients into subgroups based on their chronological age. Data of the patients who underwent RIRS due to kidney stones at our clinic between June 2014 and January 2020 were retrospectively reviewed. Patients were divided into three groups based on age: 65-74years (Group 1), 75-84years (Group 2), and ≥ 85years (Group 3). The comorbid diseases of patients were evaluated using the Charlson Comorbidity Index (CCI), total Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score, and CIRS severity index (CIRS-G SI). RIRS success rates and complications were evaluated based on age groups. A total of 336 patients were included in the study. The mean age of the patients was 72.7 ± 6.59years. Stone-free rate was 81.5% in patients aged > 65years and did not change with age. The modified Clavien-Dindo grade I/II complication rates for surgical complications were similar in all three groups (p = 0.818). In the evaluation of ROC analysis for medical complications, it was observed that the cut-off values were 76.5years, CIRS-G score of 4.5, CCI score of 2.5, and CIRS-SI score of 1.18 (p < 0.001). RIRS is an effective and safe treatment option for kidney and proximal ureteral stones in geriatric patients. Although there is an increase in medical complications post-RIRS with aging, surgical complications and stone-free rates remain unchanged.

Association between Preoperative Transthoracic Echocardiography and Clinical Outcomes after Scheduled Hip Fracture Surgery in Geriatric Patients

Association between Preoperative Transthoracic Echocardiography and Clinical Outcomes after Scheduled Hip Fracture Surgery in Geriatric Patients

Time to Surgery and Patient Mortality in Geriatric Acetabular Fractures.

To determine whether surgical intervention within 48 hours of injury results in decreased mortality in geriatric patients who have sustained acetabular fractures. Retrospective case series. University Level 1 Trauma Center. One hundred eighty-three patients 65 years of age and older who were operatively treated for acetabular fractures between 2002 and 2017. The average age was 76 years. Operative fixation of acetabular fracture. Chi square tests were used to compare 30-day, 6-month, and 1-year mortality after operative intervention between patients treated within 48 hours and after 48 hours. A Cox proportional hazard model was used to determine predictors of mortality. The overall 1-year morality was 15%. When patients were grouped by time to surgery (fracture fixation within 48 hours or after 48 hours), there were no statistically significant differences in 30-day, 6-month, or 1-year mortality between groups. In addition, there were no statistically significant differences in age, sex, mechanism of injury, fracture pattern, Charlson comorbidity index, length of hospital stay, presence of deep vein thrombosis, or quality of reduction. In the final multivariate Cox regression model of survival, increasing age was associated with a significantly increased hazard of death with a hazard ratio (HR) of 1.09 (95% confidence interval, 1.05-1.13) per year of age (P < 0.001). Patient sex, mechanism of injury, fracture pattern, estimated blood loss, and Charlson comorbidity index were not significant predictors of mortality. In contrast to the clear mortality benefits of early surgical intervention in geriatric patients with proximal femur fractures, the results of our study suggest that surgical intervention after 48 hours of injury is not associated with increased mortality rates in geriatric patients with acetabular fractures. Increased mortality was independently associated with advancing age. Sex, mechanism of injury, and facture pattern were not associated with mortality. Time to surgery in geriatric patients with acetabular fractures should be determined on an individual basis. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Delaying Elective Surgery in Geriatric Patients: An Opportunity for Preoperative Optimization.

Deciding whether to pursue elective surgery is a complex process for older adults. Comprehensive geriatric assessment (CGA) can help refine estimates of benefits and risks, at times leading to a delay of surgery to optimize surgical readiness. We describe a cohort of geriatric patients who were evaluated in anticipation of elective abdominal surgery and whose procedures were delayed for any reason. Themes behind the reasons for delay are described, and a holistic framework to guide preoperative discussion is suggested.

Immediate results of surgical treatment of advanced age patients with non-small cell lung cancer

To study the immediate results of surgical treatment of advanced age patients with non-small cell lung cancer (NSCLC). We included 190 elderly and senile patients with NSCLC who underwent surgery at the thoracic department of the Tomsk Regional Clinical Hospital in 2010-2018. There were 149 men and 41 women. Cancer stage I was observed in 67 (35%) cases, stage II - 49 (26%) patients, stage III - 69 (37%) patients, stage IV - 5 (2%) patients. Squamous cell cancer was diagnosed in 94 patients, adenocarcinoma - 78 patients, large cell lung cancer - 18 patients. Paraneoplastic inflammatory complications occurred in 26% of patients, concomitant diseases - in 99% of patients. The research included anatomic lung resection with systematic mediastinal lymph node dissection and the absence of tumor at the resection line. There were 118 lobectomies and 47 pneumonectomies. In 74 cases, combined procedures were carried out. Lobectomy with pulmonary artery resection was performed in 18 patients, lobectomy with bronchial resection - in 10 cases. Twenty-five patients underwent video-assisted lobectomy. An acceptable morbidity and mortality allow you to expand the indications for radical surgery in geriatric patients with NSCLC. However, we must establish strict indications for pneumonectomy. Bronchial and angioplastic lobectomy may be an alternative to pneumonectomy in NSCLC patients.

Predictors of Acute Kidney Injury After Hip Fracture in Older Adults.

Introduction:This study aimed to investigate the prevalence of acute kidney injury (AKI) following hip fracture surgery in geriatric patients and to identify predictors for development of AKI with a focus on possible preventable risk factors.Methods:In this retrospective cohort study, we reviewed electronic medical records of all patients above 65 years of age who underwent hip fracture surgery at Copenhagen University Hospital, Bispebjerg, Denmark, in 2018. Acute kidney injury was assessed according to the Kidney Disease Improving Global Outcomes guidelines. Multivariate logistic regression analyses were used to identify independent risk factors for AKI.Results:Postoperative AKI developed in 28.4% of the included patients (85/299). Acute kidney injury was associated with increased length of admission (11.3 vs 8.7 days, P < .001) and 30-day mortality (18/85 vs 16/214, P = .001). In multivariable analysis, higher age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.08, P = .004), heart disease (OR: 1.78, 95% CI: 1.01-3.11, P = .045), and postoperative blood transfusion (OR: 1.84, 95% CI: 1.01-3.36, P = .048) were associated with AKI. Moreover, a higher postoperative C-reactive protein (199.0 ± 99.9 in patients with AKI, 161.3 ± 75.2 in patients without AKI) and lower postoperative diastolic blood pressure were observed in patients developing AKI.Discussion and Conclusion:Acute kidney injury was common following hip fracture surgery and associated with longer admissions and increased mortality. Patients developing AKI were older and showed several postoperative similarities, including higher C-reactive protein, lower postoperative diastolic pressure, and the need for blood transfusion.

Urological-Geriatric Integrated Diagnostic-Therapeutic Pathway for elderly patients with urologic diseases

Aging of population represents a new challenge for physicians who have to deal with the balance of risk and benefit in a population that is poorly represented in clinical trials. Frail patients need individualized treatments because of their high risk of developing complications in the course of therapies. Several studies have reported the effect of frailty on falls, hospitalization and mortality, but only few have focused on surgical patients and frailty is not included in the traditional surgical risk scales. Geriatric surgery patients have a physiologic vulnerability requiring assessment beyond the traditional preoperative evaluation of adults. Although single organ evaluation cannot be ignored in elderly population, recognition of frail patients during preoperative assessment may provide additional insight in predicting poor outcome; thus, aiding preoperative decision-making. We developed a Urological-Geriatric Integrated Diagnostic-Therapeutic Pathway in order to evaluate ≥65 years old patients affected by urogenital pathologies which require major surgery and to early identify frail subject.

Is anticoagulation reversal necessary prior to surgical treatment of geriatric hip fractures?

ObjectiveHip fracture surgery in geriatric patients on anticoagulants may increase the risk for blood loss. Anticoagulation reversal may lower these risks; however, data on blood loss and transfusions are limited. The study purpose was to compare outcomes between hip fracture patients 1) not on anticoagulants 2) whose anticoagulants were reversed, and 3) whose anticoagulants were not reversed. MethodsThis four-year retrospective cohort study at six Level 1 Trauma Centers enrolled geriatric patients (≥65) with isolated hip fractures. The primary outcome was total hospital blood loss (ml). Secondary outcomes: hospital length of stay (HLOS) and volume of packed red blood cells (pRBC) transfusions (ml). Statistical analyses included: Fisher’s, chi-squared, Kruskal-Wallis, linear mixed-effect and logistic regression. Bonferroni adjusted alpha = 0.025. ResultsOf the 459 patients, 189 (41%) were not on anticoagulants, 186 (41%) were reversed, and 84 (18%) were not reversed. The LS mean (SE) blood loss was 134 ml (12) for not reversed patients and 159 (17) for reversed patients; no significant difference compared to those not on anticoagulants [138 (12)], p-diff = 0.14 and 0.83, respectively. The LS mean (SE) HLOS was significantly longer for the reversed patients, 7.7 (0.4) days, when compared to those not on anticoagulants, 6.8 (0.4), p = 0.02, and when compared to those not reversed, 6.3 (0.6), p = 0.01. There was no significant difference in pRBC transfusions. ConclusionNot reversing anticoagulants for geriatric hip fractures was not associated with increased volume of blood loss or transfusions when compared to those reversed. Delayed surgery for anticoagulant reversal may be unnecessary and contributing to an increased HLOS.

A285 It’s Never Too Late: Revisional Bariatric Surgery Appears Safe and Effective for Refractory Obesity in Advanced Age Patients

Bariatric surgery in geriatric patients (>65-years-old) has been proven safe and effective. Revisional bariatric surgery is infrequently required for cases of refractory obesity. Given rising life expectancy and the ever-growing obesity epidemic, revisional bariatric surgery will undoubtedly become more common in older patients. There is a paucity of data regarding revisional surgery the advanced age population. We hypothesize that revisional bariatric surgery is a viable and safe option in patients of advanced age.

Outcomes of bariatric surgery in geriatric patients ≥ 65 years: single institution study

Obesity is an epidemic with an increasing incidence in geriatric individuals also. The aim of the present study is to determine the outcomes in geriatric patients ≥ 65years, who underwent Bariatric Surgery. A retrospective review was performed of prospectively collected data on geriatric patients (age 65 to 80years) who had undergone bariatric surgery at a single institution from Jan. 2010 to Dec. 2013. A cohort of adult patients (age 17 to 64years) were matched for comparative evaluation who also underwent bariatric surgery in the same period. The data analyzed included gender, co-morbidities, weight (loss), complications, and resolution of co-morbidities. 184 (7.3%) patients 65years and older were identified out of 2508 patients who had bariatric surgery between January 2010 and December 2013. These were compared with 184 patients matched for types of surgery. Out of 184 patients in each group, 53 (28.8%) had undergone Roux-en-Y gastric bypass, 39 (21.2%) one anastomosis gastric bypass, and 92 (50%) sleeve gastrectomy. The average age was 68.7years and 49.85years in the geriatric and adult groups respectively. Average preoperative weight and BMI were 106.71kg and117.69kg and 42.59kg/m2 and 43.08kg/m2 in the geriatric and adult groups respectively. The co-morbid conditions were significantly more in the geriatric group. The weight (loss), nutrient deficiencies, and resolution of co-morbid conditions were similar in both groups. There were three major complications in the adult group and two in the geriatric group. One mortality was documented in the adult group from pulmonary embolus. The outcomes of bariatric surgery in geriatric patients in this study were similar to that in adults. Our study confirms the findings of previous published studies that bariatric surgery could be a safe and effective treatment option in a selected geriatric population.

Emergency general surgery in geriatric patients: How should we evaluate hospital experience?

As the aging American population poses unique challenges to acute care services, we determined if either hospital proportion or annual volume of geriatric patients undergoing emergency general surgery (EGS) procedures is associated with outcomes. Using criteria from the American Association of the Surgery of Trauma, we identified five EGS procedures in the 2012-2015 Nationwide Inpatient Sample common in geriatric patients (65+ years). We defined hospital proportion as the fraction of geriatric EGS patients divided by all EGS patients, where volume was the raw number of geriatric EGS patients. We then divided hospitals into quartiles both by proportion and then by volume of geriatric patients. Multivariable logistic regressions compared four outcomes between these quartiles: mortality, complications, failure to rescue (FTR; death after a complication), and extended length of stay (LOS; procedure-specific top decile of patients). We identified 25,084 complex EGS procedures in geriatric patients at 3,528 hospitals (mortality, 10.6%; complications, 30.5%; FTR, 27.7%; extended LOS, 9.1%). The median hospital proportion of geriatric patients among EGS procedures was 42.8% (interquartile range, 33.3-52.2%), whereas the median hospital geriatric EGS volume after nationwide weighting was 40 per year (interquartile range, 20-70/year). After adjustment, the lowest hospital proportion quartile relative to the highest was associated with adverse outcomes: mortality (odds ratio, 1.21 [95% confidence interval, 1.03-1.44]), complications (1.16 [1.05-1.29]), FTR (1.32 [1.08-1.63]), and extended LOS (1.30 [1.12-1.50]). The lowest volume quartile relative to the highest was not associated with adverse outcomes. As the hospital proportion of geriatric patients increased by 10%, the odds of all adverse outcomes decreased: mortality by 7%, complications by 4%, FTR by 9%, and extended LOS by 8%. When accounting for both, hospital proportion of geriatric EGS patients but not hospital volume is associated with postoperative outcomes, having important implications for quality improvement initiatives, benchmarking endeavors, and health services research. Care management, level IV; prognostic, level III.

Surgical Risk Assessment and Prevention in Elderly Spinal Deformity Patients.

Introduction:Prevalence of adult deformity surgery in the elderly individuals continues to increase. These patients have additional considerations for the spine surgeon during surgical planning. We perform an informative review of the spinal and geriatric literature to assess preoperative and intraoperative factors that impact surgical complication occurrences in this population.Significance:There is a need to understand surgical risk assessment and prevention in geriatric patients who undergo thoracolumbar adult deformity surgery in order to prevent complications.Methods:Searches of relevant biomedical databases were conducted by a medical librarian. Databases searched included MEDLINE, Web of Science, CINAHL, IPA, Cochrane, PQ Health and Medical, SocINDEX, and WHO’s Global Health Library. Search strategies utilized Medical Subject Headings plus text words for extensive coverage of scoliosis and surgical technique concepts.Results:Degenerative scoliosis affects 68% of the geriatric population, and the rate of surgical interventions for this pathology continues to increase. Complications following spinal deformity surgery in this patient population range from 37% to 62%. Factors that impact outcomes include age, comorbidities, blood loss, and bone quality. Using these data, we summarize multimodal risk prevention strategies that can be easily implemented by spine surgeons.Conclusions:After evaluation of the latest literature on the complications associated with adult deformity surgery in geriatric patients, comprehensive perioperative management is necessary for improved outcomes. Preoperative strategies include assessing physiological age via frailty score, nutritional status, bone quality, dementia/delirium risk, and social activity support. Intraoperative strategies include methods to reduce blood loss and procedural time. Postoperatively, development of a multidisciplinary team approach that encourages early ambulation, decreases opiate use, and ensures supportive discharge planning is imperative for better outcomes for this patient population.

Failure to Rescue After Emergency General Surgery in Geriatric Patients: Does Frailty Matter?

BackgroundFailure to rescue (FTR) is considered as an index of quality of care provided by a hospital. However, the role of frailty in FTR remains unclear. We hypothesized that the FTR rate is higher for frail geriatric emergency general surgery (EGS) patients than nonfrail geriatric EGS patients. MethodsWe performed a 3-y (2015-2017) prospective cohort study of all geriatric patients (age ≥ 65 y) requiring EGS. Frailty was calculated by using the EGS-specific Frailty Index (EGSFI) within 24 h of admission. Patients were divided into two groups: frail (FI ≥ 0.325) and nonfrail (FI < 0.325). We defined FTR as death from a major complication. Regression analysis was performed to control for demographics, type of operative intervention, admission vitals, and admission laboratory values. ResultsThree hundred twenty-six geriatric EGS patients were included, of which 38.9% were frail. Frail patients were more likely to be white (P < 0.01) and, on admission, had a higher American Association of Anesthesiologist class (P = 0.03) and lower serum albumin (P < 0.01). However, there was no difference between the groups regarding age (P = 0.54), gender (P = 0.56), admission vitals, and WBC count (P = 0.35). Overall, 26.7% (n = 85) of patients developed in-hospital complications; and mortality occurred in 30% (n = 26) of those patients (i.e., the FTR group). Frail patients had higher rates of FTR (14% vs. 4%, P < 0.001) than nonfrail patients. On regression analysis, after controlling for confounders, frail status was an independent predictor of FTR (OR: 3.4 [2.3-4.6]) in geriatric EGS patients. ConclusionsOur study demonstrates that in geriatric EGS patients, a frail status independently contributes to FTR and increases the odds of FTR threefold compared with nonfrail status. Thus, it should be included in quality metrics for geriatric EGS patients.

Colorectal surgery in elderly population.

With the rising number of elderly patients and increasing incidence of colorectal cancer, management of geriatric patients has become the forefront of colorectal surgery. This study aimed to investigate the short-term surgical outcomes following colorectal resection in elderly patients. A total of 464 patients who underwent surgical resection for colorectal tumor between 2013 and 2017 were included. The patients were divided into elderly (≥75 years) and young (&lt;75 years) group. The clinicopathological data of the patients were reviewed retrospectively. The elderly group constituted 30% of study population. More patients in elderly group underwent Hartmann procedure (p=0.02) and right hemicolectomy (p=0.029), and younger patients more often received low anterior resection (p=0.027). The surgical procedure took a shorter time in elderly group (p&lt;0.01) but they stayed in the hospital one day longer (p=0.023). Postoperative complications and mortality tended to be higher in seniors (p=0.088). The younger patients showed a tendency towards a higher rate of distant metastases (p=0.053). Seniors received fewer preoperative chemoradiation than the young group (p=0.014). Older persons constitute one-third of patients treated electively in colorectal departments. Colorectal surgery in geriatric patients is associated with a prolonged hospital stay and a higher potential for complications and mortality.

Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes.

Geriatric patients undergoing emergency general surgery (EGS) face significant morbidity and mortality. We assessed how surgeon and hospital volumes affected these outcomes. We identified patients at least 65 years old in Maryland's Health Services Cost Review Commission database from 2012 to 2014 who underwent one of 12 EGS procedures, as defined by the American Association for the Surgery of Trauma, and then calculated four outcomes: mortality rate, the incidence of at least one of eight common in-hospital EGS complications, failure-to-rescue (death after experiencing a postoperative complication), and the 30-day readmission rate. Median annual volumes of geriatric-EGS procedures divided both surgeons and hospitals into two groups (low volume and high volume). Multivariable logistic regressions calculated associations between the volume groups and outcomes after adjusting for patient, surgeon, and hospital factors, and hospital clusters. We identified 3,832 patients who had an EGS procedure by 302 surgeons (median: 8 geriatric-EGS/year, IQR: 3-18) at 44 hospitals (median: 82 geriatric-EGS/year, IQR: 35-132). While operating on 16.5% of all geriatric-EGS patients, low-volume surgeons had higher risk-adjusted adverse outcomes: mortality (7.0% vs. 4.0%, p = 0.005), in-hospital complications (22.1% vs. 19.7%, p = 0.13), failure-to-rescue (17.3% vs. 12.1%, p = 0.021), and 30-day readmissions (11.2% vs. 10.0%, p = 0.55). After adjustment, low-volume surgeons were associated with higher mortality (adjusted odds ratio [aOR] 1.86, 95% CI [1.21-2.86]) and failure-to-rescue rates (aOR 1.74 [1.09-2.80]) but not in-hospital complications (aOR 1.20 [0.95-1.51]) or 30-day readmissions (aOR 1.07 [0.85-1.34]). In contrast, low-volume hospitals relative to high-volume hospitals, and hospitals serving lower proportions of geriatric-EGS patients, were not associated with adverse outcomes. Relative to their higher-volume counterparts, surgeons performing eight or fewer geriatric-EGS procedures annually were associated with an 86% higher odds of death and 74% higher odds of failure-to-rescue in this elderly EGS patient population. These findings underscore the need for focused care of elderly surgical patients. Prognostic and epidemiological, level IV.