Cochlear Implantation in the Octogenarian and Nonagenarian :

Major surgical procedures are performed with increasing frequency in elderly persons, but the impact of age on resource use and outcomes is uncertain. To evaluate the influence of age on perioperative cardiac and noncardiac complications and length of stay in patients undergoing noncardiac surgery. Prospective cohort study. Urban academic medical center. Consecutive sample of 4315 patients 50 years of age or older who underwent nonemergent major noncardiac procedures. Major perioperative complications (cardiac and noncardiac), in-hospital mortality, and length of stay. Major perioperative complications occurred in 4.3% (44 of 1015) of patients 59 years of age or younger, 5.7% (93 of 1646) of patients 60 to 69 years of age, 9.6% (129 of 1341) of patients 70 to 79 years of age, and 12.5% (39 of 313) of patients 80 years of age or older (P < 0.001). In-hospital mortality was significantly higher in patients 80 years of age or older than in those younger than 80 years of age (0.7% vs. 2.6%, respectively). Multivariate analyses indicated an increased odds ratio for perioperative complications or in-hospital mortality in patients 70 to 79 years of age (1.8 [95% CI, 1.2 to 2.7]) and those 80 years of age or older (OR, 2.1 [CI, 1.2 to 3.6]) compared with patients 50 to 59 years of age. Patients 80 years of age or older stayed an average of 1 day more in the hospital, after adjustment for other clinical data (P = 0.001). Elderly patients had a higher rate of major perioperative complications and mortality after noncardiac surgery and a longer length of stay, but even in patients 80 years of age or older, mortality was low.

The elderly constitute an increasing portion of the world's population. Our study assessed morbidity, mortality, and outcome in octogenarians who have undergone lower intestinal operations, and compared outcome between subsequent decades. A total of 138 octogenarians who underwent 157 operations were retrospectively studied (1995-2005). The American Society of Anesthesiologists Physical Status classification, blood loss, length of surgery, surgical intensive care unit admission, length of surgical intensive care unit and hospital stay, and complications were recorded. Emergency vs. elective and cancer vs. noncancer cases were compared. Results were compared for the years 1985 to 1994. Cancer comprised 63 percent of cases. The most common causes of mortality were sepsis and multiorgan failure. Differences (P < 0.05) were found for elective vs. emergent surgeries according to age, length of stay, complications, surgical intensive care unit admission, American Society of Anesthesiologists Physical Status classification, and mortality. Noncancer cases were more likely to be emergent, have a higher American Society of Anesthesiologists Physical Status classification, and a higher mortality rate. When emergency operations were excluded, there were no significant differences between cancer vs. noncancer cases. In a comparison of two decades (1985-1994 vs. 1995-2005), we found that the mortality rate in patients younger than aged 85 years decreased by more than 10 percent (P < 0.05). Patients older than aged 85 years demonstrated no significant differences between decades. The strongest determinants of outcome are emergency status and the presence of comorbid conditions. Elective surgery in the elderly is safe. Emergency surgery is accompanied by significant morbidity and mortality.

The deterioration of speech-understanding abilities in the aged that results from factors such as reduced speed and accuracy in processing has been well documented. The purpose of this study was to evaluate whether the geriatric population could benefit from a cochlear implant, despite the possibility of reduced processing abilities. Twenty patients, ages 65 to 85 years, with bilateral profound sensorineural hearing loss received the Nucleus multichannel cochlear prosthesis at NYU Medical Center. All patients underwent extensive preoperative medical and audiologic assessments to determine candidacy. The surgical procedure was well-tolerated by all patients. Mean postoperative test results revealed significant improvements in both auditory performance and quality of life as a result of implant usage. These data support the concept that although a reduction in the processing of sensory stimulation might exist, the elderly can process a new auditory code delivered by means of a cochlear implant.