Surgery in elderly patients in Mexico. Portal hypertension surgery as an example

H. Orozco, M. A. Mercado and M. Rodriguez-Davalos
Surgical Division, Instituto Nacional de la Nutricion, Mexico City, Mexico.

Although people older than 65 years represent less than 5% of Mexico's registered population, medical care for elderly patients requires a multidisciplinary approach. In our academic university hospital, they are managed by a team of specialists. As an example of this approach, we evaluated the surgical treatment of bleeding portal hypertension in a highly selected elderly population. A retrospective study was done reviewing the files of 25 patients older than 65 years. All had good liver function (Child-Pugh class A and B) and had undergone elective surgery. Sixteen of them were women. The mean age was 68.8 years (age range, 65-76 years), and most had a diagnosis of cirrhosis. All patients were treated with portal blood flow-preserving procedures (selective shunts or Sugiura-Futagawa procedures). The operative mortality was 8%. Eight later deaths were recorded, with a mean follow-up of 25 months (range, 2-110 months). Survival (Kaplan-Meier) was 87% at 12 months, 54% at 60 months, and 45% at 110 months. Two rebleeding incidents were recorded as well as 3 cases of postoperative encephalopathy. We concluded that well-selected elderly patients, undergoing elective surgery with portal blood flow-preserving procedures, have a good postoperative outcome.