Intraoperative Factors Influencing Postoperative Outcomes in Older Patients Undergoing Abdominal Surgery—Narrative Review

The population of Europe is growing and ageing. Therefore, the number of elderly patients requiring surgical intervention is expected to rise markedly in future years. There has been considerable research into the influence of preoperative patient and disease factors on postoperative outcomes. However, information regarding the relationship between intraoperative factors, and postoperative morbidity and mortality in older patients is lacking. We aimed to review the literature concerning intraoperative factors that impact on postoperative outcomes in elderly patients. PubMed, Scopus and Embase databases (January 2006 to December 2017) were searched using the keywords of “postoperative mortality” OR “postoperative morbidity” AND elderly OR older. Fifty studies were identified for inclusion in this review. Many intraoperative factors have been identified that contribute to the extent of an individual’s reaction to a strong stimulus such as surgery. Some of these are modifiable (e.g. procedure duration, surgical method, experience of the surgeon and anaesthetist, blood loss and hypothermia) while others are not (e.g. mode of surgery and location of surgical procedure). There is a distinct lack of research on postoperative morbidity and mortality in elderly patients, especially in those with frailty syndrome. The elderly are not simply “older adults” and extrapolation of study findings from a younger population may carry a high risk of error. Therefore, further well-designed studies are needed in elderly patients, especially in those with frailty syndrome. The latter being most exposed to perioperative complications, longer hospital stays, readmissions and mortality.