The NHS should offer a 24-hour guarantee to elderly patients needing urgent surgery, national watchdogs have warned.

Experts who looked at more than 1,500 deaths within 30 days of an operation say lives could be saved if delays in treating very elderly patients were cut.

But the care of children aged under 16 has improved, according to the annual report of the National Confidential Enquiry into Perioperative Deaths.

The report highlights the care of patients over 90. It says such patients, many of whom need surgery for hip fractures, 'do not tolerate repeated episodes of pre-operative starvation, prolonged pain, sepsis or immobility' and should therefore have 'high surgical priority'. In 20 per cent of cases examined, delays to operations were for 'non-medical reasons', including lack of theatre time.

The report admits that some deaths were unavoidable. But consultant anaesthetist and co-author Dr Kathy Sherry said: 'We selected this age group to highlight problems in the care of the elderly as a whole. There are general lessons for the elderly population here.'

Managers welcomed the report but warned that more money would be needed to boost emergency surgery.

NHS Confederation policy director Nigel Edwards said: 'Even if this is going to cause logistical difficulties people will take it on board. The problem is one of resources.'

The report says care after surgery was often poor. Only 10 per cent of very elderly patients were taken to intensive care or high-dependency units, even though they often suffered from other medical problems, including high blood pressure. In 147 cases, 24-hour recovery facilities were not available.

The authors say every acute surgical hospital should have a full-time recovery area, and a high dependency unit.

And ensuring elderly patients are not dehydrated or overloaded with fluids should be as important as drug prescribing. In contrast, the inquiry found that care of children under 16 has improved. There were no deaths reported after tonsil and appendix operations and most procedures were carried out by paediatric specialists.

But co-author Dr Stuart Ingram said: 'We are calling for increased provision to allow dedicated teams to transfer critically ill children to specialist hospitals'.

Co-operation with the inquiry has improved, with 78 per cent of medical notes returned - the highest-ever level.

But missing notes were 'still a problem', according to an inquiry spokesperson.

Extremes of Age . The 1999 report of the National Confidential Enquiry into Perioperative Deaths.