Mortality associated with emergency abdominal surgery in the elderly.
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Journal: 2003/April - Canadian Journal of Surgery
ISSN: 0008-428X
PUBMED: 12691347
Abstract:
BACKGROUND
Elderly patients with life-threatening abdominal disease are undergoing emergency surgery in increasing numbers, but emergency procedures generally are associated with increased morbidity and mortality. We carried out a retrospective and prospective study at a tertiary centre in Spain to analyze the factors contributing to death after emergency abdominal surgery in elderly patients and to determine whether there were differences in the death rate between those aged 70-79 years and those aged 80 years and older.
METHODS
The study population comprised 710 patients aged 70 years or older who underwent emergency surgery for intra-abdominal disorders. Between 1986 and 1990, we reviewed the charts of 302 patients, and between 1991 and 1995, we collected prospective data on 408 patients. The patients were divided by age into 2 groups: group 1 - 364 patients aged 70-79 years; and group 2 - 346 patients aged 80 years or older. In the analysis, we considered patient age, sex, perioperative risk, the time between onset of symptoms and admission to hospital and between admission to hospital and surgery, diagnosis, type of operation, operative findings, morbidity, mortality and length of hospital stay.
RESULTS
The overall mortality was 22% (19% in group 1 and 24% in group 2). Multiple regression analysis showed that American Society of Anesthesiologists (ASA) grading (p = 0.0001), interval from onset of symptoms to admission (p = 0.007), mesenteric infarction (p = 0.005), a defunctioning stoma and palliative bypass (p = 0.003) and nontherapeutic laparotomy (p = 0.0003) were predictive of death.
CONCLUSIONS
Mortality in elderly patients operated on for an acute abdomen can be predicted by ASA grade (perioperative risk), delay in surgical treatment and conditions that permit only palliative surgery. Increasing age (70-79 yr or>> or = 80 yr) does not affect mortality, morbidity or length of hospital stay.
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Can J Surg 46(2): 111-116
PMID: 12691347

Mortality associated with emergency abdominal surgery in the elderly

From the Department of Surgery, Hospital Universitario RÍo Hortega, Valladolid, Spain
Copyright notice

Abstract

Introduction

Elderly patients with life-threatening abdominal disease are undergoing emergency surgery in increasing numbers, but emergency procedures generally are associated with increased morbidity and mortality. We carried out a retrospective and prospective study at a tertiary centre in Spain to analyze the factors contributing to death after emergency abdominal surgery in elderly patients and to determine whether there were differences in the death rate between those aged 70–79 years and those aged 80 years and older.

Methods

The study population comprised 710 patients aged 70 years or older who underwent emergency surgery for intra-abdominal disorders. Between 1986 and 1990, we reviewed the charts of 302 patients, and between 1991 and 1995, we collected prospective data on 408 patients. The patients were divided by age into 2 groups: group 1 — 364 patients aged 70–79 years; and group 2 — 346 patients aged 80 years or older. In the analysis, w

e considered patient age, sex, perioperative risk, the time between onset of symptoms and admission to hospital and between admission to hospital and surgery, diagnosis, type of operation, operative findings, morbidity, mortality and length of hospital stay. esults

The overall mortality was 22% (19% in group 1 and 24% in group 2). Multiple regression analysis showed that American Society of Anesthesiologists (ASA) grading (p = 0.0001), interval from onset of symptoms to admission (p = 0.007), mesenteric infarction (p = 0.005), a defunctioning stoma and palliative bypass (p = 0.003) and nontherapeutic laparotomy (p = 0.0003) were predictive of death.

Conclusions

Mortality in elderly patients operated on for an acute abdomen can be predicted by ASA grade (perioperative risk), delay in surgical treatment and conditions that permit only palliative surgery. Increasing age (70–79 yr or ≥ 80 yr) does not affect mortality, morbidity or length of hospital stay.

Abstract

Résumé

Introduction

Il arrive de plus en plus souvent que des patients âgés présentant une affection abdominale possiblement mortelle subissent une chirurgie d'urgence, mais les interventions d'urgence sont généralement associées à une morbidité et à une mortalité plus importantes. Nous avons effectué une étude rétrospective et prospective dans un centre tertiaire d'Espagne pour analyser les facteurs contribuant au décès après une intervention abdominale d'urgence chez les patients âgés et pour savoir si le taux de mortalité diffère entre les patients de 70 à 79 ans et ceux de 80 ans et plus.

Méthodes

La population de l'étude comprenait 710 patients de 70 ans et plus ayant subi une intervention d'urgence pour traiter un trouble intra-abdominal. Entre 1986 et 1990, nous avons passé en revue les dossiers de 302 patients, et entre 1991 et 1995, nous avons recueilli des données prospectives au sujet de 408 patients. Les patients ont été répartis en deux groupes selon l'âge : le groupe 1 comprenait 364 patients de 70 à 79 ans et le groupe 2, 346 patients de 80 ans et plus. Notre analyse tenait compte de l'âge du patient, du sexe, du risque périopératoire, de la période écoulée entre l'apparition des symptômes et l'admission à l'hôpital et de la période écoulée entre l'admission à l'hôpital et la chirurgie, du diagnostic, du type d'intervention, des constatations opératoires, de la morbidité, de la mortalité et de la durée de l'hospitalisation.

Résultats

Dans l'ensemble, la mortalité s'est établie à 22 % (19 % dans le groupe 1 et 24 % dans le groupe 2). L'analyse de régression multiple a montré que la classification de l'American Society of Anesthesiologists (ASA) (p = 0,0001), la période écoulée entre l'apparition des symptômes et l'admission (p = 0,007), l'infarctus mésentérique (p = 0,005), la stomie permanente et le pontage palliatif (p = 0,003), de même que la laparotomie non thérapeutique (p = 0,0003) étaient des prédicteurs de la mortalité.

Conclusions

La classification de l'ASA (risque périopératoire), le délai d'intervention chirurgicale et les cas dans lesquels seules des chirurgies palliatives sont praticables peuvent permettre de prédire la mortalité chez des patients âgés subissant une intervention en raison d'un abdomen aigu. L'âge croissant (70 à 79 ans ou 80 ans et plus) n'a pas d'incidence sur la mortalité, la morbidité ou la durée de l'hospitalisation.

Résumé

Notes

Competing interests: None declared.

Correspondence to: Dr. Juan J. Arenal, Plaza de Poniente nο 2, 3ο, 47003, Valladolid, Spain; fax 34-983838007; moc.oohay@evraojuj

Accepted for publication July 19, 2002.

Notes

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