Title : A meta analysis of outcomes in nonagenarians undergoing colorectal surgery
Abstract:
Objective: With an ageing population, focus has turned to surgical outcomes in the very elderly population. This meta-analysis aims to quantify the prevalence of complication and death rates amongst the very elderly population (over 90 years old) following colorectal surgery.
Data Sources: Studies covering colorectal surgery in nonagenarians up to July 2025 (without language restriction) were identified from MEDLINE, Cochrane Controlled Trials Register, and EMBASE. Additional searches were conducted using abstracts from the following conferences: ASCRS, ASCO GI, NCRI, and ASGBI.
Study Selection: No restrictions were set on studies based on the method of surgery, emergency or elective nor benign or malignant cancers. Outcomes measured included overall complications, surgical and medical complications, and post-operative death rates. Outcome data was extracted by 2 authors independently using outcome measures defined a priori. Quality assessment was performed using criteria reported by Jabs et al recommended by the EQUATOR network.
Results: Fourteen studies reported on outcomes after surgery, with the average age ranging from 90-103 years old for 847 patients. The reported overall complication and mortality rate were 46% and 11%, respectively – both of which were heterogenous. Reported surgical complications were less common compared to medical complications, with emergency complication rates being high and significantly heterogenous.
Conclusions: Elective and emergency colorectal surgery is feasible in nonagenarians. However, the mortality rate is approximately 11% with many experiencing complications. The results are heterogenous and although they are important as a broad figure, specific counselling and optimization for patients should be tailored specifically to their individual circumstance.
