The Outcome of Surgery in Patients More Than 90 Years Old-Reply

In Reply.—  We agree with Dr Phipps that quality of life is one important determinant of the ultimate utility of medical care. This issue was not addressed in our investigation, not because it was unimportant, but owing to the difficulty of assessing function in a retrospective study where, in many cases, the assessment would have to have been made by surviving family members. Indeed, a prospective study to determine functional outcomes of the very elderly in the perioperative period is currently under way at our institution.In contrast to the rather pessimistic view expressed by Dr Phipps, however, we do believe that survival without morbidity is a positive goal of medical care. In our report, we determined that both morbidity and mortality were surprisingly low in the immediate postoperative period and that both represented improvements over the figures for elderly patients that were reported by Djokevic and Hedley-Whyte¹ in