Background: As more older adults undergo surgery globally, their multimorbidity and reduced physiological reserves heighten anaesthetic risk. Evidence from low-resource settings is scarce. This study compared the frequency and types of peri-operative and early postoperative anaesthetic adverse events in patients aged 65 or older versus younger adults at Gabriel Touré University Hospital, Mali. Methods: We conducted a cross-sectional, descriptive, and analytical study in the Anaesthesia-Intensive Care Department of Gabriel Touré University Hospital from 1 July to 30 September 2024. All patients ≥ 18 years scheduled for elective surgery with anaesthesia were eligible. Patients were divided into Group I (18 - 65 years) and Group II (≥65 years). Anaesthetic risk was stratified using the American Society of Anesthesiologists (ASA) physical status classification. Emergency procedures, patients < 18 years, incomplete or lost files, and pre-operative decompensation of comorbidities were excluded. Pre-operative clinical status, comorbidities, laboratory results, and ASA class were collected. Intra-operative data included types of anaesthesia, induction technique, and haemodynamic events (tachycardia, bradycardia, hypotension, hypertension). Postoperative monitoring during the first 24 h focused on blood pressure, heart rate, oxygen saturation, and destination after the post-anaesthesia care unit. Data were analysed with IBM SPSS Statistics 22.0 using Pearson’s chi-square test (p < 0.05). Results: Of 389 patients, 86 were included (69 in Group I and 17 in Group II). Hypertension was more frequent in elderly patients (47.1% vs. 10.1%), whereas absence of medical history predominated in younger adults (85.5% vs. 52.9%) (χ 2 = 13.224; p = 0.001). Other preoperative clinical, biological, and ASA characteristics were similar between groups. General anesthesia was more often used in younger patients (65.2% vs. 35.3%; χ 2 = 5.060; p = 0.024), while regional anesthesia was preferred in older adults (64.7% vs. 33.3%; χ 2 = 5.616; p = 0.018). The incidence of intraoperative hemodynamic events and postoperative instability during the first 24 h did not differ significantly between age groups, nor did postoperative destination: approximately 87% of patients in each group were transferred to standard surgical wards and 13% to intensive care. Conclusion: In this single-centre cohort, patients aged ≥ 65 years undergoing elective surgery did not experience a higher rate of peri- or early postoperative anaesthetic complications than younger adults, provided that pre-operative assessment was rigorous and anaesthetic techniques were adapted, with greater use of regional anaesthesia. These findings support the view that chronological age alone should not contraindicate elective surgery under anaesthesia and underline the potential value of incorporating systematic frailty screening to refine risk stratification in elderly patients.
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