Mortality after abdominal emergency surgery in nonagenarians

  • Helene Perregaard
  • Jutaka Tenma
  • Jacob Antonsen
  • Tommie MynsterEmail author
Original Article



To search the pattern of diagnoses in nonagenarians undergoing emergency abdominal surgery between January 2009 and December 2013 in two hospitals. To test the hypothesis that pre-hospital functional status is an effective criterion for predicting postoperative mortality in nonagenarians after emergency abdominal surgery.


The study is an observational study on 157 patients. Patients were identified from the operation database and perioperative data were extracted as prospectively information supplied by retrospective data from patient electronic files. The primary endpoints were short, middle and long-term mortality and the secondary endpoint was to identify preoperative factors associated with postoperative mortality.


The most frequent reason for operation was intestinal obstruction. Overall mortality in the cohort was 34% (n = 54) after 30 days and 54% (n = 84) after 1 year. Amongst patients developing a serious complication (classified as Clavien Dindo class III or greater) after surgery (n = 45) the mortality was 80% (n = 36) after 30 days and 89% (n = 40) after 1 year. In multivariate analysis, a high American Association of Anesthesiologists class (ASA) and a high Performance Status (PS) class (low performance) were significant predictors of post-operative mortality.


Our data support pre-admission functional status for predicting postoperative mortality after emergency abdominal surgery in nonagenarians


Abdominal emergency surgery Frailty Nonagenarians Complications 


Author contributions

HP: Acquisition of data, drafting of manuscript; JT: Acquisition of data, critical revision of manuscript; JA: Acquisition of data, critical revision of manuscript; TM: Study conception and design, analysis and interpretation of data, critical revision of manuscript.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

Helene Perregaard declares that she has no conflict of interest. Jutaka Tenma declares that he has no conflict of interest. Jacob Antonsen declares that he has no conflict of interest. Tommie Mynster declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


  1. 1.
    Kwok AC, Semel ME, Lipsitz SR, Bader AM, Barnato AE, Gawande AA, Jha AK. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet. 2011;378(9800):1408–13.CrossRefGoogle Scholar
  2. 2.
    Massarweh NN, Legner VJ, Symons RG, McCormick WC, Flum DR. Impact of advancing age on abdominal surgical outcomes. Arch Surg. 2009;144(12):1108–14.CrossRefGoogle Scholar
  3. 3.
    Rangel EL, Cooper Z, Olufajo OA, Reznor G, Lipsitz SR, Salim A, Kwakye G, Calahan C, Sarhan M, Hanna JS. Mortality after emergency surgery continues to rise after discharge in the elderly: predictors of 1-year mortality. J Trauma Acute Care Surg. 2015;79(3):349–58.CrossRefGoogle Scholar
  4. 4.
    Arenal JJ, de Teresa G, Tinoco C, Toledano M, Said A. Abdominal surgery in nonagenarians: short-term results. Surg Today. 2007;37(12):1064–7.CrossRefGoogle Scholar
  5. 5.
    Arenal-Vera JJ, Tinoco-Carrasco C, del-Villar-Negro A, Labarga-Rodriguez F, Delgado-Mucientes A, Citores MA. Colorectal cancer in the elderly: characteristics and short term results Rev Esp Enferm Dig. 2011; 103 8: 408–15.Google Scholar
  6. 6.
    Howes TE, Cook TM, Corrigan LJ, Dalton SJ, Richards SK, Peden CJ. Postoperative morbidity survey, mortality and length of stay following emergency laparotomy. Anaesthesia. 2015;70(9):1020–7.CrossRefGoogle Scholar
  7. 7.
    Kenig J, Richter P, Olszewska U, Zychiewicz B. The prognostic role of comorbidities in older patients qualified for emergency abdominal surgery. Polski Prz Chir. 2015;86(12):569–75.Google Scholar
  8. 8.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med. 2003;29(4):530–8.CrossRefGoogle Scholar
  9. 9.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefGoogle Scholar
  10. 10.
    Cooper Z, Scott JW, Rosenthal RA, Mitchell SL. Emergency major abdominal surgical procedures in older adults: a systematic review of mortality and functional outcomes. J Am Geriatr Soc. 2015;63(12):2563–71.CrossRefGoogle Scholar
  11. 11.
    McGillicuddy EA, Schuster KM, Davis KA, Longo WE. Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. Arch Surg. 2009;144(12):1157–62.CrossRefGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ, UKEL Network. Variations in mortality after emergency laparotomy: the first report of the UK emergency laparotomy network. Br J Anaesth. 2012;109(3):368–75.CrossRefGoogle Scholar
  14. 14.
    Svenningsen P, Manoharan T, Foss NB, Lauritsen ML, Bay-Nielsen M. Increased mortality in the elderly after emergency abdominal surgery. Dan Med J. 2014;61(7):A4876.PubMedGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    Lees MC, Merani S, Tauh K, Khadaroo RG. Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis. Can J Surg. 2015;58(5):312–7.CrossRefGoogle Scholar
  17. 17.
    Sharrock AE, McLachlan J, Chambers R, Bailey IS, Kirkby-Bott J. Emergency abdominal surgery in the elderly: can we predict mortality?.World J Surg. 2017; 41 2: 402–9.Google Scholar
  18. 18.
    Davis P, Hayden J, Springer J, Bailey J, Molinari M, Johnson P. Prognostic factors for morbidity and mortality in elderly patients undergoing acute gastrointestinal surgery: a systematic review. Can J Surg. 2014;57(2):E44–E52.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the edmonton frail scale. Age Ageing. 2006;35(5):526–9.CrossRefGoogle Scholar
  20. 20.
    Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, et al. Frailty as a predictor of surgical outcomes in older patients J Am Coll Surg. 2010; 210 6: 901–8.Google Scholar
  21. 21.
    Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2009;48(1):78–83.CrossRefGoogle Scholar
  22. 22.
    Kenig J, Zychiewicz B, Olszewska U, Barczynski M, Nowak W. Six screening instruments for frailty in older patients qualified for emergency abdominal surgery. Arch Gerontol Geriatr. 2015;61(3):437–42.CrossRefGoogle Scholar
  23. 23.
    Joseph B, Zangbar B, Pandit V, Fain M, Mohler MJ, Kulvatunyou N, Jokar TO, O'Keeffe T, Friese RS, Rhee P. Emergency general surgery in the elderly: too old or too frail? J Am Coll Surg. 2016;222(5):805–13.CrossRefGoogle Scholar
  24. 24.
    Scarborough JE, Pappas TN, Bennett KM, Lagoo-Deenadayalan S. Failure-to-pursue rescue: explaining excess mortality in elderly emergency general surgical patients with preexisting “do-not-resuscitate” orders. Ann Surg. 2012;256(3):453–61.CrossRefGoogle Scholar
  25. 25.
    Merani S, Payne J, Padwal RS, Hudson D, Widder SL, Khadaroo RG. Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World J Emerg Surg. 2014;9:43.CrossRefGoogle Scholar
  26. 26.
    Harnsberger CR, Maykel JA, Alavi K. Postoperative Ileus. Clin Colon Rectal Surg. 2019;32(3):166–70.CrossRefGoogle Scholar
  27. 27.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315 8: 801–10.Google Scholar
  28. 28.
    Sartelli M, Kluger Y, Ansaloni L, Hardcastle TC, Rello J, Watkins RR, Bassetti M, Giamarellou E, Coccolini F, Abu-Zidan FM, et al. Raising concerns about the Sepsis-3 definitions. World J Emerg Surg. 2018; 13: 6.Google Scholar
  29. 29.
    Rhee C, Klompas M. New sepsis and septic shock definitions: clinical implications and controversies. Infect Dis Clin North Am. 2017;31(3):397–413.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Digestive Disease CenterBispebjerg University HospitalCopenhagenDenmark
  2. 2.The Department of SurgeryHerlev University HospitalCopenhagenDenmark

Personalised recommendations