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Results of emergency colectomy in nonagenarians and octogenarians previously labeled as prohibitive surgical risk



There are no standardized criteria for what constitutes prohibitive risk for emergency abdominal surgery.


A retrospective review was performed comparing two groups of patients having emergent colectomy. One group had previously been labeled as being prohibitive surgical risk and the other was a contemporary, non-prohibitive risk group also requiring emergency colectomy. All operations were performed by a single surgeon.


There were 27 prohibitive risk patients and 81 non-prohibitive risk (control group) patients. The average age of the prohibitive risk group was 85 years (range 78–99) compared to the control group mean age of 52 years (18–79, p < 0.00001). Prohibitive risk was due to extremes of age combined with congestive heart failure in 44%, followed by chronic obstructive pulmonary disease combined with heart failure in 19%. The groups were closely matched by the type of colectomy performed. The total complication rate was much higher in the prohibitive risk group compared to the non-prohibitive risk patients (81% versus 48%, p 0.005). But the 30-day mortality rate was similar between groups (7% versus 4%, p 0.6).


Patients who are labeled as prohibitive surgical risk may be inaccurately assessed in the majority of cases. Additional research will need to be performed to evaluate the presence of quantifiable high-risk physiological conditions, and not just comorbidities, that place a patient at high risk of death after abdominal surgery. Until then, elderly patients should not be denied colectomy based upon comorbidities alone.

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Congestive heart failure


Chronic obstructive pulmonary disease


Heart failure with reduced ejection fraction


American Society of Anesthesiologists


Myocardial infarction

C. diff:

Clostridioides difficile


American College of Surgeons


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No funding was received for conducting this study.

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Authors and Affiliations



Both authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JAC and TN. The first draft of the manuscript was written by JAC and all authors commented on previous versions of the manuscript. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to John Alfred Carr.

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Conflict of interests

Neither author has any conflicts of interest nor any financial disclosures to declare, except that the lead author is one of the section editors for the European Journal of Trauma and Emergency Surgery.

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Carr, J.A., NeCamp, T. Results of emergency colectomy in nonagenarians and octogenarians previously labeled as prohibitive surgical risk. Eur J Trauma Emerg Surg (2022).

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  • Emergency
  • Colectomy
  • Prohibitive risk
  • Nonagenarians
  • Risk assessment