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Increased Morbidity and Mortality of Emergency Laparotomy in Elderly Patients

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Abstract

Background

There is an increasing incidence of elderly patients requiring emergency laparotomy. Our study compares the outcomes of elderly patients undergoing emergency laparotomy against the outcomes of non-elderly patients.

Methodology

Patients who underwent emergency laparotomy between 2015 and 2017 from the National University Hospital, Singapore, were included. Apart from demographic data, indication of surgery and surgical procedure performed were collected. Prospectively collected nutritional scores were evaluated. Outcome measures included duration of surgery, length of ICU and total hospital stay, post-operative complications, and mortality indices. We performed multivariate Cox regression analysis to determine the contribution of various risk factors towards overall survival following emergency laparotomy.

Results

A total of 170 emergency laparotomies were performed. Compared to non-elderly patients, elderly patients had a significantly longer mean stay in hospital (31.5 vs. 18.6 days, p = 0.006) and mean stay in ICU (13.1 vs. 5.3 days, p = 0.003). More elderly patients suffered from post-laparotomy complications compared with non-elderly patients (65.8% vs. 37.4%, p < 0.001). 30-day mortality (31.5% vs. 8.8%, p = 0.019) and 1-year mortality (27.9% vs. 14.3%, p = 0.023) were higher in elderly patients compared with non-elderly patients. Interestingly, there was no statistically significant difference between elderly and non-elderly groups in both the global 3-MinNS as well as the global SGA nutritional scores. ASA status (HR 2.61, 95% CI 1.05–6.45, p = 0.038) was an independent risk factor for decreased survival following emergency laparotomy. Notably, while age ≥ 65 demonstrated a significant correlation with survival on univariate analysis (HR 1.03 (1.01–1.05), p = 0.003), this effect was lost following multivariate regression (HR 1.01 (0.453–2.23), p = 0.989).

Conclusion

Elderly patients suffer worse morbidity and mortality following emergency laparotomy. This is likely contributed by comorbidities resulting in higher ASA status.

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Funding

All authors have obtained no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work, and no other relationships or activities that could appear to have influenced the submitted work.

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Authors and Affiliations

  1. Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Melissa Sin Hui Chua & Dedrick Kok Hong Chan

  2. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Dedrick Kok Hong Chan

Authors
  1. Melissa Sin Hui Chua
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  2. Dedrick Kok Hong Chan
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Contributions

MSHC participated in the collection of data, the analysis of data, and the drafting and final editing of the manuscript. DKHC participated in the writing of the manuscript, the collection of data, the analysis of data, the drafting and final editing of the manuscript, and overall management of the manuscript.

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Correspondence to Dedrick Kok Hong Chan.

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Chua, M.S.H., Chan, D.K.H. Increased Morbidity and Mortality of Emergency Laparotomy in Elderly Patients. World J Surg 44, 711–720 (2020). https://doi.org/10.1007/s00268-019-05240-3

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  • DOI: https://doi.org/10.1007/s00268-019-05240-3

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