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Etiologies and outcomes of emergency surgery for acute abdominal pain: an audit of 1456 cases in a single center

  • Yuichi TakayamaEmail author
  • Yuji Kaneoka
  • Atsuyuki Maeda
  • Yasuyuki Fukami
  • Takamasa Takahashi
  • Masahito Uji
Original Article
  • 58 Downloads

Abstract

Purpose

There are few studies that have reported the details of emergency surgery for acute abdominal pain. This study aimed to clarify the etiologies and outcomes of emergency abdominal surgery among patients in different age categories.

Methods

Between January 2014 and December 2016, 1456 patients aged 7 years or older who underwent emergency surgery for acute abdominal pain at our institution were enrolled in this study. The patients were divided into three age groups: 7–17 years (n = 146), 18–64 years (n = 628), and 65 years or older (n = 682). The clinical characteristics, etiology of abdominal emergency surgery, and surgical outcomes were compared among the three groups.

Results

The proportion of patients with comorbid conditions significantly increased with increasing ages. In patients in between 7 and 17 and in those between 18 and 64 years, acute appendicitis was the most frequent etiology, followed by bowel obstruction. Conversely, the most frequent etiology was bowel obstruction, followed by biliary disease in patients 65 years or older. The morbidity and mortality rate were 12% and 0.2% in patients 18–64 years, and 25% and 1.8% in patients 65 years or older (P < 0.001 and P = 0.004, respectively). In the group of patients 65 years or older, more patients were transferred to different hospitals for rehabilitation or recovery.

Conclusions

This study demonstrated significant differences among patients in different age categories in terms of the etiologies and outcomes of emergency abdominal surgery.

Keywords

Emergency surgery Acute abdominal pain Ethiology Surgical outcome 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose. Patient anonymity was preserved.

References

  1. 1.
    Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012;5:789–97.CrossRefGoogle Scholar
  2. 2.
    Lameris W, van Randen A, van Es HW, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ. 2009;338:b2431.CrossRefGoogle Scholar
  3. 3.
    Brewer BJ, Golden GT, Hitch DC, et al. Abdominal pain. An analysis of 1000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976;131:219–23.CrossRefGoogle Scholar
  4. 4.
    Eskelinen M, Ikonen J, Lipponen P. Contributions of history-taking, physical examination, and computer assistance to diagnosis of acute small-bowel obstruction. A prospective study of 1333 patients with acute abdominal pain. Scand J Gastroenterol. 1994;29:715–21.CrossRefGoogle Scholar
  5. 5.
    Irvin TT. Abdominal pain: a surgical audit of 1190 emergency admissions. Br J Surg. 1989;76:1121–5.CrossRefGoogle Scholar
  6. 6.
    Sheridan WG, White AT, Havard T, et al. Non-specific abdominal pain: the resource implications. Ann R Coll Surg Engl. 1992;74:181–5.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Onoe S, Kaneoka Y, Maeda A, et al. Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72 h of symptom onset. Updates Surg. 2016;68:377–83.CrossRefGoogle Scholar
  8. 8.
    Mori H, Kaneoka Y, Maeda A, et al. Determination of therapeutic strategy for adhesive small bowel obstruction using water-soluble contrast agents: an audit of 776 cases in a single center. Surgery. 2017;162:139–46.CrossRefGoogle Scholar
  9. 9.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8.CrossRefGoogle Scholar
  10. 10.
    Murata A, Okamoto K, Mayumi T, et al. Age-related differences in outcomes and etiologies of acute abdominal pain based on a national administrative database. Tohoku J Exp Med. 2014;233:9–15.CrossRefGoogle Scholar
  11. 11.
    Mayumi T, Yoshida M, Tazuma S, et al. Practice guidelines for primary care of acute abdomen 2015. J Hepatobiliary Pancreat Sci. 2016;23:3–36.CrossRefGoogle Scholar
  12. 12.
    Joseph B, Zangbar B, Pandit V, et al. Emergency general surgery in the elderly: too old or too frail? J Am Coll Surg. 2016;222:805–13.CrossRefGoogle Scholar
  13. 13.
    Akinbami F, Askari R, Steinberg J, et al. Factors affecting morbidity in emergency general surgery. Am J Surg. 2011;201:456–62.CrossRefGoogle Scholar
  14. 14.
    Fukuda N, Wada J, Niki M, et al. Factors predicting mortality in emergency abdominal surgery in the elderly. World J Emerg Surg. 2012;7:12.CrossRefGoogle Scholar
  15. 15.
    Foster NM, McGory ML, Zingmond DS, et al. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006;203:170–6.CrossRefGoogle Scholar
  16. 16.
    van Geloven AA, Biesheuvel TH, Luitse JS, et al. Hospital admissions of patients aged over 80 with acute abdominal complaints. Eur J Surg. 2000;166:866–71.CrossRefGoogle Scholar
  17. 17.
    Lewis LM, Banet GA, Blanda M, et al. Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. J Gerontol A Biol Sci Med Sci. 2005;60:1071–6.CrossRefGoogle Scholar
  18. 18.
    Oomen JL, Engel AF, Cuesta MA. Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors. Colorectal Dis. 2006;8:112–9.CrossRefGoogle Scholar
  19. 19.
    Bo M, Cacello E, Ghiggia F, et al. Predictive factors of clinical outcome in older surgical patients. Arch Gerontol Geriatr. 2007;44:215–24.CrossRefGoogle Scholar
  20. 20.
    Monaco A, Verna C, Gastaldi L, et al. [Emergency abdominal surgery in the aged]. Minerva Chir. 1996;51:1043–7.PubMedGoogle Scholar
  21. 21.
    Arenal JJ, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg. 2003;46:111–6.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryOgaki Municipal HospitalOgakiJapan

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