The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States

Ann Surg. 2021 Jul 14;10.1097/SLA.0000000000005077. doi: 10.1097/SLA.0000000000005077. Online ahead of print.


Objective: The objective of this study was to estimate the incidence and cumulative risk of major surgery in older persons over a 5-year period and evaluate how these estimates differ according to key demographic and geriatric characteristics.

Background: As the population of the United States ages, there is considerable interest in ensuring safe, high-quality surgical care for older persons. Yet, valid, generalizable data on the occurrence of major surgery in the geriatric population are sparse.

Methods: We evaluated data from a prospective longitudinal study of 5,571 community-living fee-for-service Medicare beneficiaries, aged 65 or older, from the National Health and Aging Trends Study (NHATS) from 2011 to 2016. Major surgeries were identified through linkages with Centers for Medicare & Medicaid Services data. Population-based incidence and cumulative risk estimates incorporated NHATS analytic sampling weights and cluster and strata variables.

Results: The nationally-representative incidence of major surgery per 100 person-years was 8.8, with estimates of 5.2 and 3.7 for elective and non-elective surgeries. The adjusted incidence of major surgery peaked at 10.8 in persons 75-79 years, increased from 6.6 in the non-frail group to 10.3 in the frail group, and was similar by sex and dementia. The 5-year cumulative risk of major surgery was 13.8%, representing nearly 5 million unique older persons, including 12.1% in persons 85-89 years, 9.1% in those ≥90 years, 12.1% in those with frailty, and 12.4% in those with probable dementia.

Conclusions: Major surgery is a common event in the lives of community-living older persons, including high-risk vulnerable subgroups.