An audit of surgical emergencies in the very old.

The surgical emergency admissions of patients over the age of 80 years at the hospitals of the West Berkshire Health Authority during 1989 have been analysed. The results were then compared with those of 1976 and 1966 in an attempt to identify any changing trends. The total number of admissions increased by almost 37% from 248 in 1976 to 339 in 1989. There was a dramatic increase in those patients admitted with gastrointestinal problems. The average length of stay was less in 1989, being 9 days compared with 15 days in 1976; this was despite the fact that the average length of stay for all ages was comparable for the 2 years in question. The overall mortality rate has not appreciably altered being 21.8% in 1976 and 22.4% in 1989. Excluding terminal disease the mortality rates were 12.5% and 15.9% for 1976 and 1989 respectively. Despite the increased numbers of patients admitted the total beds occupied by the over 80s has actually fallen between 1976 and 1989, due to their shorter hospital stay. Figures for the year 2000 predict a continuing increase in the number of elderly patients in the community. It is unlikely that we will be able to reduce hospital stay much further and therefore the total number of beds occupied by the very old in the acute surgical ward will rise steadily.