Surgery in the Geriatric Patient: Are We Defining the Right Measure for Successful Outcome?

Zenilman's commentary¹ concisely summarized factors that contributed to improved survival of elderly patients after elective and emergencysurgery. It should also be mentioned that advances in medical technology, intensive care, and artificial organ support have permitted survival of elderly patients after extensive and often complex surgical procedures. Hospitalization of elderly patients for elective or emergent surgery can result in functional decline and limitations in activities of daily living, representing an important trigger for disability in the community.² Hospital discharge of elderly patients to care facilities or nursing homes is common because of incomplete or delayed recovery of independent function.³ Under such conditions, survival after adjusting for the decline in quality of life does not always translate into desirable outcome for elderly patients. Functional dependency in activities of daily living and transfer to care facilities are associated with an increased risk for postdischarge mortality in the elderly population.³ Functional decline and care dependency after hospital discharge also have profound long-term negative effects on caregivers and family members.⁴ While hospital survival may be considered a measure for success, it is almost certain that enhanced quality of life is the real desirable outcome and goal for elderly patients and their caregivers. It is imperative to shift the traditional paradigm for successful outcome from quantitative to qualitative survival. If quality-of-life–adjusted survival becomes the benchmark for the evaluation of surgical outcome, then it is feasible to succeed in providing patient- and family-centered medical care for elderly patients.