Thoracic surgery in the elderly

Abstract

The increase in the age expectancy leads to an increased demand for thoracic surgery by elderly patients. These patients present significant physiologic changes and comorbidities that have to be considered. The purpose of this study was to characterize the elderly population and its complications after thoracic surgery.

In this retrospective cohort study, we considered all patients aged ≥75 years that were submitted to thoracic surgery in a central hospital over a 4-year period.

A total of 81 patients were included, with a mean age of 77.0 years and a male predominance of 61.7%. They presented a median FVC of 96% and a median FEV1 of 90%. Most of the surgeries (85.2%) were motivated for tumors. In 77.9% the tumor was intrathoracic and in 7.4% the aim of the surgery was to resect lung metastasis of extrathoracic tumors. In most of the cases (88.9%) the surgical approach was through video-assisted thoracoscopic surgery. The median admission duration was 6.0 days. There were no significant intra-surgery complications. 28.4% presented complications in the sequence of the procedure. The more frequent complications were cardiovascular events (8.8%), long-lasting air leak, (6.3%) and nosocomial infections (5.1%). 3.6% of the patients died in the admission. The patients that had complications presented an admission duration almost three times than the others (p<0.001).

In this cohort of elderly patients, we found that cardiac complication was the major complication associated with thoracic surgery and that the duration of admission is determined by the presence of complications.This set of patients involves special characteristics and selection, but this should not demotivate the thoracic surgery in the elderly as they had a relatively small complication rate.