Asian Journal of Healthy and Science

p-ISSN: 2980-4302

e-ISSN: 2980-4310

Vol. 3 No. 1 January 2024

RELATIONSHIP BETWEEN PATIENT AGE AND POSTOPERATIVE

COMPLICATIONS: STEMATIC LITERATURE REVIEW

William Kusuma

Banggai Regional General Hospital, Indonesia

Email: kusumawilliam@yahoo.com

Abstract

Surgery is one of the medical procedures that can be performed to treat various

diseases. However, surgery can also cause complications. The purpose of this study

was to examine the relationship between patient age and postoperative

complications. This study used the Systematic Literature Review research method.

Research data were collected from literature published in reputable scientific

journals. The literature was collected through searches in electronic literature

databases, such as Google Schoolar and Scopus. The data that has been collected is

then analyzed in three stages, namely data reduction, data presentation and

conclusion drawing. The results showed that patient age is one of the risk factors for

postoperative complications. Elderly patients have a higher risk of developing

postoperative complications, compared to young patients.

Keywords: Patient Age, Complications, Postoperative

INTRODUCTION

Surgery is a medical procedure performed to treat or treat an illness, injury, or

other medical condition. Although surgery is often effective in treating diseases or

reducing the symptoms experienced by patients, like other medical procedures,

surgery also has a risk of complications. The National Cancer Institute explains that

in medical science, the meaning of complications is a medical problem that occurs

during having a disease or after undergoing certain procedures or treatments (Laudia

Tysara, 2022)

According to WHO (2020), the number of patients undergoing surgery

continues to increase every year (Mantika et al., 2023). There are an estimated 165

million surgeries performed annually worldwide, with 234 million patients in

hospital in 2020. In Indonesia, surgery in 2020 reached 1.2 million patients. Based

on data from the Indonesian Ministry of Health (2021), surgery occupies the 11th

position out of 50 disease treatments in Indonesia, with 32% of them being elective

surgery. The pattern of disease in Indonesia is estimated to consist of 32% major

surgery, 25.1% mental disorders, and 7% anxiety (Ramadhan et al., 2023).

In Itani's study in Canada, it was found that the postoperative complication rate

was 47% with a recurrence rate of 8% in the Lichtenstein technique, and 35% with a

recurrence rate of 12% in laparoscopy (Ulfandi & Jeo, 2019). Research LUKMAN

et al., (2022) found the prevalence of the most types of cataracts, senile cataracts

(99%), the rest were juvenile (0.75%) and congenital (0.25) cataracts. The youngest

age of patients undergoing cataract surgery was 0.4 years (4 months) and the oldest

age was 95 years, the average age of patients obtained was 61.92 ± SD 11.72 years,

the most were female (53.75%). The prevalence of postoperative cataract

complications occurs mostly using EKEK surgery techniques (48.5%). The

prevalence of the most common types of postoperative cataract complications is

corneal edema, using the EKEK technique as much as 35% and phacoemulsification

as much as 32.5%.

Postoperative complications are a possibility that can be experienced by

patients of various age ranges, although the risk tends to be higher in elderly patients.

The factors that cause increased risk in this age group involve natural physiological

changes that occur with aging. Organs, such as the heart, lungs, and kidneys,

generally experience decreased function, so responding to postoperative stress can be

more difficult. In addition, the immune system that tends to decrease in old age

increases the patient's vulnerability to infection (Astari, 2018). The purpose of this

study was to examine the relationship between the age of patients and postoperative

complications.

RESEARCH METHODS

This study used the Systematic Literature Review research method. The

Systematic Literature Review (SLR) method is a thorough process carried out

systematically to identify, evaluate, and synthesize research relevant to a particular

topic. This method involves certain steps to collect, review, and analyze existing

literature in a methodical and structured manner (F. Rozi, 2020).

The research data was collected from literature published in reputable scientific

journals. Literature is collected through searches in electronic literature databases,

such as Google Schoolar and Scopus. The data used in this study has several

inclusion criteria, including Indonesian or English with a publication period of 2013-

2023. While the inclusion criteria are in addition to Indonesian and English and

published before 2013. Based on the criteria that have been determined, the flow and

results of the research to be used in this study are depicted in the following PRISMA

diagram.

RESULTS AND DISCUSSION

Table 1. Research Results

Author Name

and Year

Heading

Research Results

(Satkunasivam

et al., 2020)

Relation between

surgeon age and

postoperative outcomes:

a population-based

cohort study

Patient mortality rates,

hospital readmissions, and

complications decline in

Ontario as surgeons age.

Increasing surgeon age is

associated with decreased

postoperative mortality,

rehospitalization, and

complications in an almost

Author Name

and Year

Heading

Research Results

linear way after accounting for

factors at the patient,

procedure, surgeon, and

hospital levels. Further

evaluation of the mechanisms

underlying these findings can

help improve patient safety and

outcomes, as well as inform

policies on maintenance of

certification and retirement age

for surgeons.

(Lin et al., 2016)

Frailty and post-

operative outcomes in

older surgical patients: a

systematic review

There is strong evidence that

frailty in elderly and oldest

surgical patients predicts

postoperative mortality,

complications, and long length

of stay. Flaw assessment may

be a valuable tool in

perioperative assessment. It is

possible that tools with

different weaknesses are best

suited for different acuity and

types of surgical patients.

(I. F. Rozi et al.,

2021)

The Relationship

Between Patient Age,

Fracture Type and

Location of Long Bone

Fracture on Post-

Surgical Hospitalization

at Orthopedic Hospital

Prof. Dr. R. Soeharso

Surakarta

In theory, fractures in geriatric

patients have a longer healing

due to comorbid diseases.

Diabetes and hypertension can

cause a decrease in bone

mineral density so that it has a

longer healing time. Elderly

patients are also susceptible to

pneumonia and also deep vein

trhombosis which of course

can extend the length of

hospitalization in fracture

patients.

(Pramono &

Desfitra, 2023)

The relationship

between age and

postoperative chills

Younger patients have less

chills because they have more

subcutaneous fat that protects

them from cold, stable resting

muscle tone, high metabolic

rate, their ability to regulate

and maintain normal body

temperature effectively better

than in old age, and

thermoregulation at a young

Author Name

and Year

Heading

Research Results

age. signifikan lebih baik

daripada umur tua

(Widiyono &

Setiyajati, 2020)

Relationship between

Age and Duration of

Surgery with

Hypothermia in Post-

Spinal Anesthesia

Patients at Central

Surgical Installations

Based on the hypothesis test

with logistic regression

analysis tests, it is known that

age is a risk factor for

hypothermy with a p

coefficient of 0.025 < 0.05 and

an odds ratio value of 8.985,

meaning that respondents who

are getting older are 8.985

times more at risk of

hypothermy.

(Handayani et

al., 2022)

Correlation Between

Age And Hypothermic

Incidence Of Post

Operation Patients With

General Anesthesia At

Pku Muhammadiyah

Hospital, Bantul

Based on the results of the

study, it was found that there

was a relationship between age

and the incidence of

postoperative hypothermia

with general anesthesia. The

level of closeness of the

relationship between age and

the incidence of hypothermy

can also be seen based on the

incidence rate according to the

age range where patients with

the age range of children tend

to experience severe

hypothermy, amounting to 4

out of 10 patients (10%),

adolescents tend to experience

mild and moderate

hypothermy, amounting to 5

patients each (12.5%), the adult

age category tends to

experience hypothermia with

moderate temperature criteria,

which amounts to 5 out of 10

patients (12.5%) while For the

elderly category, they tend to

experience severe hypothermy,

amounting to 8 out of 10

patients (20%)

(WIDJAJANA,

2017)

The relationship of

hypospadias type, age,

and surgical technique

to complications of

In bivariate analysis, there was

no significant association

between the age of surgery for

hypospadias and

Author Name

and Year

Heading

Research Results

ureoquataneous fistula

in pediatric hypospadias

complications of

urethrocutaneous fistula and

the strength of the weak

relationship (p value = 0.21

and r value = 0.28).

(Ulfandi & Jeo,

2019)

Comparison of the

Incidence of

Postoperative

Complications of

Herniorafi with the

Lichtenstein Technique

Mesh with

Laparoscopic

Techniques at RSCM

There are differences in the

incidence of postoperative

herniorafi complications with

the mesh of the Lichtenstein

technique and laparoscopic

techniques in patients with

inguinal hernia which shows

that the incidence of

complications appears more in

the Lichtenstein technique

than laparoscopy with factors

of length of stay and type of

surgery that significantly

significant the incidence of

postoperative complications.

The variables age, length of

surgery, and body mass index

were not significantly

associated with postoperative

complications of the two

techniques (p = >0.05).

(Rivai et al.,

2013)

Determinants of

Postoperative Cesarean

Wound Infection

Risk factors for ILO events in

cesarean section are the time of

prophylactic antibiotics, the

length of preoperative

hospitalization and the length

of postoperative care. Other

factors, including respondents'

age, nutritional status, type of

surgery, preoperative hemo-

globin, type of anesthesia, and

length of surgery, were not

found to be risk factors for ILO

events in post-cesarean

patients.

(Sidhi et al.,

2021)

The relationship

between the rule of ten

and the incidence of

post-labioplasty

complications

The age of patients undergoing

labioplasty surgery was

dominated by the age of over

10 weeks, which was 84

patients (97.7%). Almost all

cleft patients who had

Author Name

and Year

Heading

Research Results

undergone labioplasty weighed

over 4.5 kg as many as 85

patients (98.8%) and

hemoglobin levels above 10 g /

dL were found in 83 patients

(96.5%). Of the 86 cleft

patients, about 80 patients

(93%) met the rule of ten

criteria. A total of 7 patients

(8.1%) had complications.

Surgery or surgery is an invasive treatment by opening or displaying body parts,

and is generally done by making incisions on the body parts to be handled and

repaired and ending with closing and suturing wounds. Surgery is performed for

several reasons such as diagnostic (biopsy, laparotomy, exploration), curative

(excision of tumor masses, removal of inflammatory appendices), reparative

(repairing multiple wounds), reconstruction and palliative (Apriansyah et al in Rizki

et al, 2019). Surgery according to its type is divided into two types, namely major and

minor surgery. Minor surgery is surgery on a small part of the body that has a smaller

risk of complications than major surgery. Usually patients who undergo minor

surgery can go home the same day. While major surgery is an operation that involves

organs widely and has a high level of risk to client survival (Talindong & Minarsih,

2020).

The overall success of surgery depends largely on the pre-operative phase. This

is because this phase is the initial phase which is the foundation for the next stage. In

the pre-operative phase, nurses play an important role in preparing the physical and

psychological condition of patients who will undergo surgery. This pre-operative

phase begins when the decision for surgical intervention has been made and ends

when the patient is sent to the operating room (Putri & Martin, 2020). The

preparation for surgery is carried out on patients starting from the time the patient

enters the treatment room until the patient is in the operating room before the surgery

is performed. Patients who will undergo surgery really need to be considered in

overcoming the anxiety experienced (Kurniawan et al., 2018).

Various bad possibilities can occur that will be dangerous for patients. So do

not be surprised if often patients and families show excessive attitudes with the

anxiety experienced. Fear of pain after surgery, fear of physical changes (becoming

ugly and not functioning normally), fear of malignancy (if the diagnosis is uncertain),

fear or anxiety of experiencing the same condition as others who have the same

disease, fear of facing the operating room, surgical equipment and officers, fear of

death during anesthesia, and fear of surgery will fail are various reasons that can

cause fear or anxiety of patients in facing surgery (Sutinah, 2019). So that nurses have

a role in providing information to patients and their families regarding the illness

suffered and future treatment plans. The information provided must use effective and

clear information. Interpersonal communication is at the core of the job for a nurse.

All nursing tasks revolve around the need for nurses to be effective informers, one of

which is in providing informed consent (Murdiman et al., 2019).

The provision of information about the disease and the actions to be taken

needs to be given to each patient, as the rights and obligations of patients receiving

treatment in the hospital (Law-RI, No. 44 concerning Hospitals, 2009). Most patients

feel that their anxiety level becomes lighter if they know information about the

purpose of the examination, and the preoperative procedures to be carried out

(Tamah et al., 2019)

In addition to preoperative care, postoperative patient care can also be complex

due to physiological changes that may occur, including bleeding complications,

irregular heart rhythms, respiratory disorders, circulation, temperature control

(hypothermy), as well as other vital functions such as neurological function, skin

integrity and wound condition, genito-urinary, gastrointestinal, fluid and electrolyte

balance and comfort (Siswoyo & Siyoto, 2020). Postoperative complications have a

significant and sustained effect on the patient's quality of life after surgery; these

effects worsen as the severity of complications increases (Downey et al., 2023).

Postoperative complications are a common disorder associated with poor clinical

outcomes; thus, structural and procedural changes should be implemented to reduce

postoperative morbidity and mortality (Satkunasivam et al., 2020)

Medical complications are associated with a twofold increase in pain that limits

function 1-3 months after surgery. Understanding the mechanisms linking

complications to pathological persistence of pain could help develop future

approaches to preventing pain that persists after surgery (Moleong, 1989).). Pain is

an unpleasant feeling, cannot be handed over to others and it is caused by special

mechanical, chemical, electrical stimuli, found at the ends of the nerves. Pain is one

of the things that affect the comfort of the body. Being free from pain is a basic need

that humans must overcome (Sidharti & Kurniawaty, 2023). Postoperative nausea

and vomiting or PONV (Post Operative Nausea and Vomiting) is still a common

problem in nursing services. The incidence of PONV (Post Operative Nausea and

Vomiting) occurs in 25-30% of postoperative patients under general anesthesia and

can reach 70% in postoperative patients with high risk (Rahmayana et al., 2014).

One of the factors that cause the presence or absence and speed or duration of

postoperative effects is the age of the patient. According to Lin et al., (2016) there is

strong evidence that weakness in elderly surgical patients and the oldest surgical

patients predicts postoperative mortality, complications, and long length of

hospitalization. Flaw assessment may be a valuable tool in perioperative assessment.

It is possible that tools with different weaknesses are best suited for different acuity

and types of surgical patients.

Elderly patients are also susceptible to pneumonia and deep vein trhombosis

which of course can extend the length of hospitalization in patients (I. F. Rozi et al.,

2021). Younger patients have less chills because young people have more

subcutaneous fat that protects them from cold conditions, resting muscle tone is

stable, metabolic rate is still high, their ability to regulate and maintain normal body

temperature effectively is better than in old age, and thermoregulation measures at a

young age are significantly better than in old age (Pramono & Desfitra, 2023).

Postoperative hypothermia is a core temperature lower than normal body

temperature of 36oC after the patient is operated on. Under normal circumstances,

the human body is able to regulate temperature in hot and cold environments through

a temperature-protective reflex regulated by the hypothalamus. During general

anesthesia, the reflex ceases to function, making the patient very susceptible to

hypothermia. About 33-56.7% of patients undergoing spinal anesthesia experience

wheezing events (Tubalawony & Siahaya, 2023).

According to Handayani et al., (2022) stated that the level of closeness of the

relationship between age and the incidence of hypothermy can also be seen based on

the incidence rate according to the age range where patients with the age range of

children tend to experience severe hypothermy, amounting to 4 out of 10 patients

(10%), adolescents tend to experience mild and moderate hypothermy, which

amounts to 5 patients each (12.5%), The adult age category tends to experience

hypothermy with moderate temperature criteria, amounting to 5 out of 10 patients

(12.5%), while for the elderly category tends to experience severe hypothermy, which

amounts to 8 out of 10 patients (20%). However, the statement of Ulfandi & Wifanto

(2019), on the contrary, is that the age variable does not have a significant

relationship with postoperative complications. Supported by Rivai et al (2013) who

stated that other factors such as respondents' age, nutritional status, type of surgery,

preoperative hemo-globin, type of anesthesia, and duration of surgery, were not

found as risk factors for ILO events in postoperative patients.

CONCLUSION

Elderly patients have a higher susceptibility to postoperative complications

compared to younger patients. These age-related differences underscore the

importance of considering age as an important factor in assessing and managing the

potential risks associated with surgical procedures. As patients age, there is an

inherent increase in the likelihood of facing complications during the postoperative

period. The findings emphasize the need for tailored and attentive care for elderly

patients undergoing surgery, focusing on proactive measures to mitigate the

increased risk and ensure a smoother recovery process.

Widiyono et al (2020) age is a risk factor for hypothermy with a coefficient p

0.025 < 0.05 and an odds ratio value of 8.985 meaning that respondents who are

getting older are 8,985 times more at risk of hypothermy.

BIBLIOGRAPHY

Astari, P. (2018). Katarak: Klasi Kasi, Tatalaksana, dan Komplikasi Operasi. Cermin

Dunia Kedokteran, 45(10), 748–753.

Downey, C. L. … Meads, D. M. (2023). Impact of in-hospital postoperative

complications on quality of life up to 12 months after major abdominal surgery.

British Journal of Surgery, znad167.

Handayani, T. … ST, S. (2022). Hubungan antara usia dengan kejadian hipotermi

pasien pasca operasi dengan general anestesi di RS PKU Muhammadiyah

Bantul. Universitas’ Aisyiyah Yogyakarta.

Kurniawan, A. … Triyoga, A. (2018). Pengetahuan pasien pre operasi dalam

persiapan pembedahan. Jurnal Penelitian Keperawatan, 4(2).

Laudia Tysara. (2022). Arti Komplikasi adalah Gambaran dari Kerumitan, Simak

Penjelasannya. In liputan6. Liputan6.com.

https://www.liputan6.com/hot/read/4911088/arti-komplikasi-adalah-

gambaran-dari-kerumitan-simak-penjelasannya?page=2. Diakses pada 29

Desember 2023.

Lin, H.-S. … Hubbard, R. E. (2016). Frailty and post-operative outcomes in older

surgical patients: a systematic review. BMC Geriatrics, 16(1), 1–12.

LUKMAN, N. … Amin, R. (2022). PREVALENSI KOMPLIKASI

PASCAOPERASI KATARAK DENGAN TEKNIK EKEK DAN

FAKOEMULSIFIKASI DI RUMAH SAKIT KHUSUS MATA

MASYARAKAT PROVINSI SUMATERA SELATAN TAHUN 2018-2020.

Sriwijaya University.

Mantika, E. … Saputra, R. (2023). Hubungan Komunikasi Terapeutik Perawat

Terhadap Tingkat Kecemasan Pasien Pre Operatif Di Rumah Sakit Kanker

Dharmais. Innovative: Journal Of Social Science Research, 3(6), 3942–3954.

Moleong, L. J. (1989). Metodologi penelitian kualitatif. (No Title).

Murdiman, N. … Solo, T. P. (2019). Hubungan Pemberian Informed Consent

Dengan Kecemasan Pada Pasien Pre Operasi Appendisitis Di Ruang Bedah

BLUD Rumah Sakit Konawe. Jurnal Keperawatan, 2(03), 1–8.

Pramono, A., & Desfitra, R. (2023). Hubungan Umur dengan Kejadian Menggigil

Pasca Operasi. Cerdika: Jurnal Ilmiah Indonesia, 3(7), 657–662.

Putri, S. B., & Martin, W. (2020). FAKTOR INTERNAL DAN EKSTERNAL

YANG BERHUBUNGAN DENGAN TINGKAT KECEMASAN PASIEN

PRE-OPERASI MAYOR DI RUANG RAWAT INAP BEDAH. Jurnal

NTHN: Nan Tongga Health And Nursing, 14(1), 60–67.

Rahmayana, R. … Damayati, D. S. (2014). Hubungan pola asuh ibu dengan kejadian

stunting anak usia 24-59 bulan di posyandu asoka ii wilayah pesisir kelurahan

Barombong kecamatan Tamalate kota Makassar Tahun 2014. Al-Sihah: The

Public Health Science Journal.

Ramadhan, D. … Fitri, N. (2023). Pengaruh Konseling dengan Pendekatan,

Thinking, Feeling dan Acting (TFA) terhadap Tekanan Darah pada Pasien Pre

Operasi. Jurnal Penelitian Perawat Profesional, 5(2), 637–644.

Rivai, F. … Utarini, A. (2013). Determinan infeksi luka operasi pascabedah sesar.

Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health

Journal), 8(5), 235–240.

Rozi, F. (2020). Systematic Literature Review pada Analisis Prediktif dengan IoT:

Tren Riset, Metode, dan Arsitektur. Jurnal Sistem Cerdas, 3(1), 43–53.

Rozi, I. F. … Nugroho, H. (2021). Hubungan Usia Pasien, Jenis Fraktur dan Lokasi

Fraktur Tulang Panjang Terhadap Lama Rawat Inap Pasca Bedah di RS

Ortopedi Prof. Dr. R. Soeharso Surakarta: The Relationship of Patient Age,

Fracture Type and Location of Long Bone Fracture to Length of Stay Post-

Surgery at the Orthopedic Hospital Prof. Dr. R. Soeharso Surakarta. Jurnal

Sains Dan Kesehatan, 3(5), 661–666.

Satkunasivam, R. … Wallis, C. J. D. (2020). Relation between surgeon age and

postoperative outcomes: a population-based cohort study. CMAJ, 192(15),

E385–E392.

Sidharti, L., & Kurniawaty, E. (2023). Efek Samping Sectio Caesarea Metode

ERACS (Literature Review). Medical Profession Journal of Lampung, 13(2),

34–37.

Sidhi, S. P. … Balatif, R. (2021). Hubungan Antara Rule of Ten Terhadap Kejadian

Komplikasi Pasca Labioplasty. Majalah Kedokteran Andalas, 44(4), 232–235.

Siswoyo, C., & Siyoto, S. (2020). Analisis Faktor yang Berpengaruh terhadap

Peningkatan Biaya Perawatan Pasca Operasi di Instalasi Bedah Sentral RSUD

Kabupaten Jombang. Jurnal Penelitian Dan Pengembangan Kesehatan

Masyarakat Indonesia, 1(1).

Sutinah, S. (2019). Pengaruh Tehnik Distraksi Auditori Terhadap Tingkat

Kecemasan Klien Preoperasi Appendisitis. Jurnal Kesehatan Indonesia, 10(1),

11–16.

Talindong, A., & Minarsih, M. (2020). Pengaruh Pelayanan Kebutuhan Spiritual

terhadap Tingkat Kecemasan Pasien Pre Operasi di Rumah Sakit Woodward.

Jurnal Ilmiah Kesmas-IJ, 20(1), 64–72.

Tamah, Z. G. … Yulia, S. (2019). Hubungan Pemenuhan Informasi Pasien Pre

Operasi Dengan Tingkat Kecemasan Di Rumah Sakit XX Palembang. Jurnal

Berita Ilmu Keperawatan, 12(1), 31–36.

Tubalawony, S. L., & Siahaya, A. (2023). Pengaruh Anestesi Spinal terhadap

Kejadian Hipotermi pada Pasien Post Operasi. Jurnal Keperawatan, 15(1), 331–

338.

Ulfandi, D., & Jeo, W. S. (2019). Perbandingan Insiden Komplikasi Pascaoperasi

Herniorafi dengan Mesh Teknik Lichtenstein dengan Teknik Laparoskopi Di

RSCM. Jurnal Llmu Bedah Indonesia, 47(1), 97–110.

Widiyono, W., & Setiyajati, A. (2020). Hubungan antara usia dan lama operasi

dengan hipotermi pada pasien paska anestesi spinal di instalasi bedah sentral.

Jurnal Ilmu Keperawatan Medikal Bedah, 3(1), 55.

WIDJAJANA, D. P. (2017). Hubungan Tipe Hipospadia, Usia, Dan Teknik Operasi

Terhadap Komplikasi Fistula Uretrokutaneus Pada Kasus Hipospadia Anak.

William Kusuma (2023)

First publication right:

AJHS - Asian Journal of Healthy and Science

This article is licensed under a Creative Commons Attribution-ShareAlike 4.0

International