Top

Published in:

01-07-2018 | Original Scientific Report

Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies

Authors: Hassen Hentati, Chady Salloum, Philippe Caillet, Eylon Lahat, Mara Disabato, Eric Levesque, Philippe Compagnon, Chetana Lim, Daniel Azoulay

Published in: World Journal of Surgery | Issue 7/2018

Abstract

Background

Emergency digestive surgery is being increasingly performed in elderly patients. The aim of the present study was to identify the predictors of mortality and morbidity following emergency digestive surgery in patients aged 80 years and older.

Methods

A single-center retrospective review was performed of consecutive patients aged ≥65 years operated for a digestive surgical emergency between January 2011 and December 2013. Two groups were compared: group A (aged 65–79 years) and group B (aged ≥80 years).

Results

The study population included 185 patients: 76 patients in group A and 109 in group B. The mean age was 79.9 years (65–104 years). The overall 90-day mortality rate was 23.2 and 31.9% at 1 year, which was similar between groups. The overall morbidity was 28.6%. No differences were noted between the two groups in overall, minor (Dindo I–II) or major (Dindo III–IV) morbidity rates. Multivariate analysis identified pulmonary disease (odds ratio, OR = 6.43, p = 0.02), bowel ischemia (OR = 11.41, p = 0.01), postoperative ICU stay (OR = 7.37, p < 0.0001) and the occurrence of postoperative complications (OR = 2.66, p = 0.03) as predictors of 90-day mortality. Predictors of in-hospital morbidity were preoperative hemoglobin <12 g/dL (OR = 2.49, p = 0.02) and postoperative intensive care unit (ICU) stay (OR = 6.69, p < 0.0001). An age ≥80 year was not associated with mortality or morbidity in this study.

Conclusions

The decision to perform abdominal surgery in the emergency setting should be based on physiological status, which accounts for a patient’s comorbidities and health status, rather than on chronological age per se.

Katlic MR (2001) Principles of geriatric surgery. In: Rosenthal RA, Zenilman ME, Katlic MR (eds) Principles and practice of geriatric surgery. Springer, New York, pp 92–104CrossRef

Duron JJ, Duron E, Maneglia R (2005) Digestive surgery in the elderly. J Chir (Paris) 142(3):50–159CrossRef

Turrentine FE, Wang H, Simpson VB et al (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203(6):865–877CrossRefPubMed

Walter LC, Covinsky KE (2001) Cancer screening in elderly patients: a framework for individualized decision making. JAMA 285(21):2750–2756CrossRefPubMed

Smith OK (1967) Advanced age as a contraindication to operation. Med Rec (NY) 72:642–644

Oschner A (1967) Is risk of operation too great in the elderly? Geriatrics 22(11):121–130

Wheatley BJ, Gorsuch JM, Ashraf Mansour M et al (2011) Vascular procedures in nonagenarians and centenarians are safe. Am J Surg 201(3):301–304CrossRefPubMed

Arenal JJ, Bengoechea-Beeby M (2003) Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 46(2):111–116PubMedPubMedCentral

Pelavski AD, Lacasta A, de Miguel M et al (2013) Mortality and surgical risk assessment among the extreme old undergoing emergency surgery. Am J Surg 205(1):58–63CrossRefPubMed

10.

Hall WH, Ramachandran R, Narayan S et al (2004) An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer 20(4):94CrossRef

11.

Evans DC, Cook CH, Christy JM et al (2012) Comorbidity-polypharmacy scoring facilitates outcome prediction in older trauma patients. J Am Geriatr Soc 60(8):1465–1470CrossRefPubMed

12.

Mirbagheri N, Dark JG, Watters DA (2010) How do patients aged 85 and older fare with abdominal surgery? J Am Geriatr Soc 58(1):104–108CrossRefPubMed

13.

Frenkel WJ, Jongerius EJ, Mandjes-van Uitert ML et al (2014) Validation of the Charlson Comorbidity Index in acutely hospitalized elderly adults: a prospective cohort study. J Am Geriatr Soc 62(2):342–346CrossRefPubMed

14.

Duron JJ, Duron E, Dugue T et al (2011) Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 254(2):375–382CrossRefPubMed

15.

Fukuda N, Wada J, Niki M et al (2012) Factors predicting mortality in emergency abdominal surgery in the elderly. World J Emerg Surg 7(1):12CrossRefPubMedPubMedCentral

16.

Gürleyik G, Gürleyik E, Unalmişer S (2002) Abdominal surgical emergency in the elderly. Turk J Gastroenterol 13(1):47–52PubMed

17.

Nishida K, Okinaga K, Miyazawa Y et al (2000) Emergency abdominal surgery in patients aged 80 years and older. Surg Today 30(1):22–27CrossRefPubMed

18.

Zerbib P, Kulick JF, Lebuffe G et al (2005) Emergency major abdominal surgery in patients over 85 years of age. World J Surg 29(7):820–825. https://doi.org/10.1007/s00268-005-7855-4 CrossRefPubMed

19.

Green G, Shaikh I, Fernandes R et al (2013) Emergency laparotomy in octogenarians: a 5-year study of morbidity and mortality. World J Gastrointest Surg 5(7):216–221CrossRefPubMedPubMedCentral

20.

Rubinfeld I, Thomas C, Berry S et al (2009) Octogenarian abdominal surgical emergencies: not so grim a problem with the acute care surgery model? J Trauma 67(5):983–989CrossRefPubMed

21.

Racz J, Dubois L, Katchky A et al (2012) Elective and emergency abdominal surgery in patients 90 years of age or older. Can J Surg 55(5):322–328CrossRefPubMedPubMedCentral

22.

Tan KY, Chen CM, Ng C et al (2006) Which octogenarians do poorly after major open abdominal surgery in our Asian population? World J Surg 30(4):547–552. https://doi.org/10.1007/s00268-005-0224-5 CrossRefPubMed

23.

Merani S, Payne J, Padwal RS et al (2014) Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World J Emerg Surg 7(9):43CrossRef

24.

Du Y, Karvellas CJ, Baracos V et al (2014) Acute Care and Emergency Surgery (ACES) Group. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery. Surgery 156(3):521–527CrossRefPubMed

25.

Cooper Z, Mitchell SL, Gorges RJ et al (2015) Predictors of mortality up to 1 year after emergency major abdominal surgery in older adults. J Am Geriatr Soc 63(12):2572–2579CrossRefPubMedPubMedCentral

26.

Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381(9868):752–762CrossRefPubMed

27.

Farhat JS, Velanovich V, Falvo AJ et al (2012) Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg 72(6):1526–1530CrossRefPubMed

28.

Chen CC, Chen CN, Lai IR et al (2014) Effects of a modified hospital elder life program on frailty in individuals undergoing major elective abdominal surgery. J Am Geriatr Soc 62(2):261–268CrossRefPubMedPubMedCentral

29.

Arora VM, McGory ML, Fung CH (2007) Quality indicators for hospitalization and surgery in vulnerable elders. J Am Geriatr Soc 55(Suppl 2):S347–S358CrossRefPubMed

30.

Desserud KF, Veen T, Søreide K (2016) Emergency general surgery in the geriatric patient. Br J Surg 103(2):e52–e61CrossRefPubMed

31.

Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Variation in hospital mortality associated with inpatient surgery. N Engl J Med 361(14):1368–1375CrossRefPubMed

32.

Buettner S, Gani F, Amini N et al (2016) The relative effect of hospital and surgeon volume on failure to rescue among patients undergoing liver resection for cancer. Surgery 159(4):1004–1012CrossRefPubMed

33.

Rix TE, Bates T (2007) Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery. World J Emerg Surg 5(2):16CrossRef

Title: Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies
Authors: Hassen Hentati
Chady Salloum
Philippe Caillet
Eylon Lahat
Mara Disabato
Eric Levesque
Philippe Compagnon
Chetana Lim
Daniel Azoulay
Publication date: 01-07-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4419-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2018

Which Patients Require Extended Thromboprophylaxis After Colectomy? Modeling Risk and Assessing Indications for Post-discharge Pharmacoprophylaxis

Operations for Suspected Neoplasms in a Resource-Limited Setting: Experience and Challenges in the Eastern Democratic of Congo

Preoperative Prognostic Nutritional Index Predicts Long-Term Surgical Outcomes in Patients with Esophageal Squamous Cell Carcinoma

Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Inflammation-Based Prognostic Score Predicts Postoperative Survival of Patients with Interstitial Pneumonia After Undergoing Lung Cancer Resection

The Effect of Intraoperative Nefopam Administration on Acute Postoperative Pain and Chronic Discomfort After Robotic or Endoscopic Assisted Thyroidectomy: A Randomized Clinical Trial