Top

European Journal of Trauma and Emergency Surgery

Published in:

01-04-2022 | Basic Surgery | Original Article

Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study

Authors: Mattia Portinari, Lara Bianchi, Alessandro De Troia, Giorgia Valpiani, Savino Spadaro, Alberto Fogagnolo, Pierfilippo Acciarri, Giorgio Soliani, Paolo Carcoforo

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2022

Abstract

Purpose

The primary aim of this study was to evaluate the 30-day survival of nonagenarian patients who underwent non-traumatic emergency abdominal surgery. Other aims were: 90-day and 12-month survival rates, the postoperative complications rate, the impact of the emergency operation on postoperative functional status, the accuracy of the P-POSSUM in predicting 30-day postoperative mortality and changes in care services after surgery.

Methods

This was a retrospective cohort study of nonagenarian patients who underwent non-traumatic emergency abdominal surgery between January 2010 and June 2017. Patients were divided in two groups according to the 30-day survival status to compare the distribution of patients’ characteristics and postoperative outcomes. Overall survival was estimated using the Kaplan–Meier method. To assess the accuracy of P-POSSUM to predict 30-day mortality, a receiver operating characteristic curve and the Hosmer–Lemeshow goodness of fit test were used.

Results

85 nonagenarian patients were enrolled in this study; of these, 27 (31.8%) died within 30 days. The Kaplan–Meier curve showed a rapid decline in survival over the first 30 postoperative days, followed by a more gradual reduction during the rest of the first year. The majority of patients (92.6%) who died within 30 days experienced a medical complication, with a preponderance of respiratory failure (48.2%) and multiple organ failure (33.3%). In the surviving patients, the postoperative functional status had worsened, and 64.2% of patients did not return to their original housing situation or were institutionalized. The accuracy of P-POSSUM in predicting 30-day mortality in nonagenarian patients was poor.

Conclusions

This study may help doctors convey the postoperative risks of morbidity and mortality, and also to adequately inform relatives about the possible adverse discharge destination of surviving nonagenarian patients with a consequent increase in care needs.

Available only for authorised users

Kotzeva M. Demographic changes—profile of the population. In: Kotzeva M, editor. People in the EU: who are we and how do we live? Luxembourg: Publications Office of the European Union; 2015. p. 21–42.

Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865–77. https://doi.org/10.1016/j.jamcollsurg.2006.08.026.CrossRefPubMed

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56. https://doi.org/10.1093/gerona/56.3.m146.CrossRefPubMed

Pelavski AD, De Miguel M, Rochera MI, Lacasta A, Roca M. Immediate postoperative and mid-term survival in nonagenarians undergoing non-traumatic emergency surgery. Minerva Anestesiol. 2014;80(7):796–804.PubMed

Whiteley MS, Prytherch DR, Higgins B, Weaver PC, Prout WG. An evaluation of the POSSUM surgical scoring system. Br J Surg. 1996;83(6):812–5.CrossRefPubMed

Oliver CM, Walker E, Giannaris S, Grocott MP, Moonesinghe SR. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. Br J Anaesth. 2015;115(6):849–60. https://doi.org/10.1093/bja/aev350.CrossRefPubMed

Loc PTB, du Montcel ST, Duron JJ, Levard H, Suc B, Descottes B, et al. Elderly POSSUM, a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients. Br J Surg. 2010;97(3):396–403. https://doi.org/10.1002/bjs.6903.CrossRef

Gomes A, Rocha R, Marinho R, Sousa M, Pignatelli N, Carneiro C, et al. Colorectal surgical mortality and morbidity in elderly patients: comparison of POSSUM, P-POSSUM, CR-POSSUM, and CR-BHOM. Int J Colorectal Dis. 2015;30(2):173–9. https://doi.org/10.1007/s00384-014-2071-z.CrossRefPubMed

Lawrence VA, Hazuda HP, Cornell JE, Pederson T, Bradshaw PT, Mulrow CD, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004;199(5):762–72. https://doi.org/10.1016/j.jamcollsurg.2004.05.280.CrossRefPubMed

10.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.CrossRefPubMed

11.

Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10(1):20–30.CrossRefPubMed

12.

Newgard CD, Lewis RJ. Missing data: how to best account for what is not known. JAMA. 2015;314(9):940–1. https://doi.org/10.1001/jama.2015.10516.CrossRefPubMed

13.

Racz J, Dubois L, Katchky A, Wall W. Elective and emergency abdominal surgery in patients 90 years of age or older. Can J Surg. 2012;55(5):322–8. https://doi.org/10.1503/cjs.007611.CrossRefPubMedPubMedCentral

14.

Aucoin S, McIsaac DI. Emergency general surgery in older adults: a review. Anesthesiol Clin. 2019;37(3):493–505. https://doi.org/10.1016/j.anclin.2019.04.008.CrossRefPubMed

15.

Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM. Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg. 2012;114(3):640–51. https://doi.org/10.1213/ANE.0b013e318240d6eb.CrossRefPubMed

16.

Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. 2002;89(4):622–32. https://doi.org/10.1093/bja/aef220.CrossRefPubMed

17.

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–9. https://doi.org/10.1016/s0895-4356(96)00236-3.CrossRefPubMed

18.

Berian JR, Mohanty S, Ko CY, Rosenthal RA, Robinson TN. Association of loss of independence with readmission and death after discharge in older patients after surgical procedures. JAMA Surg. 2016;151(9):e161689. https://doi.org/10.1001/jamasurg.2016.1689.CrossRefPubMed

19.

Sudlow A, Tuffaha H, Stearns AT, Shaikh IA. Outcomes of surgery in patients aged >/=90 years in the general surgical setting. Ann R Coll Surg Engl. 2018;100(3):172–7. https://doi.org/10.1308/rcsann.2017.0203.CrossRefPubMedPubMedCentral

Title: Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study
Authors: Mattia Portinari
Lara Bianchi
Alessandro De Troia
Giorgia Valpiani
Savino Spadaro
Alberto Fogagnolo
Pierfilippo Acciarri
Giorgio Soliani
Paolo Carcoforo
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Basic Surgery
Abdominal Surgery
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01646-8

At a glance: The STEP trials

Springer Medicine

Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2022

Effects of the first lockdown of the COVID-19 pandemic on the trauma surgery clinic of a German Level I Trauma Center

Repeat CT after blunt head trauma and Glasgow Coma Scale score 13–15 without neurological deterioration is very low yield for intervention

Evaluation of a standardized instrument for post hoc analysis of trauma-team-activation-criteria in 75,613 injured patients an analysis of the TraumaRegister DGU®

Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade

More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

Surgical management of displaced femoral neck fractures in patients with dementia: a comparison in mortality between hemiarthroplasty and pins/screws