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Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The primary aim of this study was to evaluate the 30-day survival of nonagenarian patients who underwent non-traumatic emergency abdominal surgery. Other aims were: 90-day and 12-month survival rates, the postoperative complications rate, the impact of the emergency operation on postoperative functional status, the accuracy of the P-POSSUM in predicting 30-day postoperative mortality and changes in care services after surgery.

Methods

This was a retrospective cohort study of nonagenarian patients who underwent non-traumatic emergency abdominal surgery between January 2010 and June 2017. Patients were divided in two groups according to the 30-day survival status to compare the distribution of patients’ characteristics and postoperative outcomes. Overall survival was estimated using the Kaplan–Meier method. To assess the accuracy of P-POSSUM to predict 30-day mortality, a receiver operating characteristic curve and the Hosmer–Lemeshow goodness of fit test were used.

Results

85 nonagenarian patients were enrolled in this study; of these, 27 (31.8%) died within 30 days. The Kaplan–Meier curve showed a rapid decline in survival over the first 30 postoperative days, followed by a more gradual reduction during the rest of the first year. The majority of patients (92.6%) who died within 30 days experienced a medical complication, with a preponderance of respiratory failure (48.2%) and multiple organ failure (33.3%). In the surviving patients, the postoperative functional status had worsened, and 64.2% of patients did not return to their original housing situation or were institutionalized. The accuracy of P-POSSUM in predicting 30-day mortality in nonagenarian patients was poor.

Conclusions

This study may help doctors convey the postoperative risks of morbidity and mortality, and also to adequately inform relatives about the possible adverse discharge destination of surviving nonagenarian patients with a consequent increase in care needs.

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Data availability

All data generated or analysed during this study are included in this published article.

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Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy

    Mattia Portinari, Alessandro De Troia, Giorgio Soliani & Paolo Carcoforo

  2. Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy

    Lara Bianchi

  3. Research Innovation Quality and Accreditation Unit, University Hospital of Ferrara, Ferrara, Italy

    Giorgia Valpiani

  4. Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesiology and Intensive Care, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy

    Savino Spadaro & Alberto Fogagnolo

  5. Department of Surgery, Unit of Vascular Surgery, University Hospital of Ferrara, Ferrara, Italy

    Pierfilippo Acciarri

  6. Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italia

    Mattia Portinari

  7. Dipartimento Chirurgico, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna di Ferrara, Via Aldo Moro, 8 | Stanza 2 34 39 (1C2), 44124, Ferrara, Cona, Italia

    Mattia Portinari

Authors
  1. Mattia Portinari
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  2. Lara Bianchi
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  3. Alessandro De Troia
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  4. Giorgia Valpiani
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  8. Giorgio Soliani
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  9. Paolo Carcoforo
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Contributions

MP, LB, and PC: conception and design; AF, PA, ADT, and GS: acquisition of data; MP, GV, and SS: analysis and interpretation of data; MP, LB, and PC: drafting the article; ADT, GV, SS, AF, PA, and GS: critical revision of the article; MP, LB, ADT, GV, SS, AF, PA, GS, and PC: final approval of the version; MP, LB, ADT, GV, SS, AF, PA, GS, and PC: agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Mattia Portinari.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest/competing interests.

Ethics approval

This study was approved by the Institutional Review Board at the University Hospital of Ferrara (Ethical Committee for Human Subject Research Study Number: CE-AVEC 87/2018/Oss/AOUFe).

Consent to participate

Patients still alive and available signed a written informed consent, while a consent waiver was approved by the ethics committee for deceased and unavailable patients.

Consent for publication

Patients still alive and available signed a written informed consent, while a consent waiver was approved by the ethics committee for deceased and unavailable patients.

Supplementary Information

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Supplementary file1 (DOCX 34 KB)

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Portinari, M., Bianchi, L., De Troia, A. et al. Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study. Eur J Trauma Emerg Surg 48, 1205–1216 (2022). https://doi.org/10.1007/s00068-021-01646-8

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  • DOI: https://doi.org/10.1007/s00068-021-01646-8

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