Ambulatory general surgery safe for older adults when patients are carefully selected

Editor's Note

Older age alone should not exclude patients from ambulatory general surgery. A retrospective study published in Cureus on August 27 found that patients over 75 undergoing short-stay general surgical procedures experienced complication and reintervention rates comparable to younger peers, despite higher comorbidity and anesthetic risk scores.

The analysis included 405 patients treated between 2020 and 2023, with 205 over 75 and 200 under 75. Older patients had significantly higher ASA classifications and Charlson Comorbidity Index scores. Even so, 30-day surgical reintervention rates were similar (1.0% in older patients vs 2.0% in younger; p = 0.394), and complication rates were nearly identical (17.1% vs 15.5%; p = 0.668). Most complications were minor (Clavien-Dindo grade I-II). Only 1% of older adults required hospitalization longer than 24 hours.

A striking difference was observed in unplanned emergency department visits, which were less frequent in the older cohort (1.0% vs 4.5%; p = 0.029). Procedure types, including hernia repairs and thyroidectomies, were evenly distributed between groups. The findings support the notion that functional status, frailty, and comorbidity burden are more meaningful predictors of safety than age alone. The study emphasizes the importance of comprehensive preoperative evaluation, careful patient selection, and continuity of care in extending the benefits of ambulatory surgery to older populations.

The authors note expanding access will require integrating geriatric-focused protocols such as structured frailty assessments, prehabilitation, and tailored follow-up. While the single-center, retrospective design limits generalizability, the results contribute real-world evidence that day surgery can be both safe and efficient for patients over 75 when approached with individualized planning.