Abdominal Emergency Surgery in the Elderly: How to Predict Mortality?

Abstract

Introduction: Elderly patients are exposed to high mortality rate in emergency surgery. Aim: The aim of the present study was to identify the factors which predict mortality among elderly patients ≥70 years, operated for an abdominal emergency. Materials and Methods: In the present study, a case-control study including patients of age group 70 years and older, operated for abdominal emergency in the Emergency Surgery Department between January 2008 and December 2013. The present study, compared 70-year-old patients who died after having undergone urgent abdominal surgery. Death Group (DG) including 50 consecutive patients with a Control Group (CG) including 50 patients. A consecutive list of all patients (291) of age group 70 years and older was established according to the admission registry of the emergency surgery department. A numeric code was assigned to each patient. All the 50 patients in CG were randomly selected from this list. The predictive mortality factors were analysed in a multivariate the study. The contribution of scores and indexes was also evaluated. Results: The risk factors which were identified in the univariate analyses were delay in hospital admission ≥48 hours, impaired general condition, dehydration, haemodynamic or respiratory preoperative instability, delay in surgical treatment ≥24 hours, laparotomy procedures, peritonitis, mesenteric ischaemia or gastrointestinal metastases diagnosed during surgery, complications, the need for Intensive Care Unit (ICU) stay, and finally the use of intubation. American Society of Anaesthesiologist (ASA) score, Charlson index and Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) were also predictive of mortality. In the multivariate analyses, delay in surgical treatment ≥24 hours, laparotomy procedures and the need of ICU stay were independent predictors of mortality. Conclusion: In the elderly, the delay of surgery ≥24 hours, the laparotomy procedure and ICU stay are independent predictors of mortality. The scores and the indexes are objective and reliable evidences. This visibility of the evolution of patients; undergone emergency surgery would adapt the management, target a sub population more exposed and provide the patients with the most enlightened information possible.

Keywords

• gastrointestinal
• laparotomy
• predictors