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Emergency Abdominal Operations in the Elderly: A Multivariate Regression Analysis of 430 Consecutive Patients with Acute Abdomen

World Journal of Surgery volume 39, pages 2854–2861 (2015)Cite this article

Abstract

Background

This study is intended to ascertain if outcome of acute abdominal surgery among elderly patients with acute abdominal pain have improved.

Methods

Altogether 456 patients aged >65 years underwent emergency abdominal surgery between the years 2007 and 2009 in our hospital. After excluding emergency reoperations of elective surgery, a total of 430 consecutive patients were included in this retrospective audit. The key factors under analysis in this study were the occurrence of major complications and death from any cause within 30 days after the operation. In addition, we compared our results to our previously published data some 20 years ago.

Results

The most common diagnoses were cholecystitis (n = 139, 32.3 %, incidence of 125 per 100,000 elderly persons), incarcerated hernia (n = 60, 13.9 %, 54/100,000), malignancy related (n = 50, 11.6 %, 45/100,000), or acute appendicitis (n = 46, 10.7 %, 41/100,000). The majority of operations (80.7 %) were performed using open technique. Of all 112 laparoscopic procedures, 25.9 % were converted to open surgery. Reoperations were rare and postoperative surgical complications were not associated with statistically significant increase in mortality, even if reoperation was needed. The 30-day mortality and morbidity rates were 14.2 and 31.9 %, respectively. Logistic regression analysis showed that patient’s age (p = 0.014), atrial fibrillation (p = 0.017), low body mass index (p = 0.001), open surgery (p = 0.029), ASA grade III or more (p < 0.001), and previous history of malignancies (p = 0.010) were likely to increase mortality.

Conclusions

Despite modern diagnostics and improved surgical techniques, the results of emergency abdominal surgery still have relatively high morbidity and mortality as reported in earlier studies.

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Authors and Affiliations

  1. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland

    Mika Ukkonen

  2. Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland

    Mika Ukkonen

  3. Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland

    Antti Kivivuori

  4. Department of Gastrointestinal Surgery, University of Eastern Finland, Kuopio, Finland

    Tuomo Rantanen & Hannu Paajanen

Authors
  1. Mika Ukkonen
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  2. Antti Kivivuori
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  4. Hannu Paajanen
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Correspondence to Mika Ukkonen.

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Ukkonen, M., Kivivuori, A., Rantanen, T. et al. Emergency Abdominal Operations in the Elderly: A Multivariate Regression Analysis of 430 Consecutive Patients with Acute Abdomen. World J Surg 39, 2854–2861 (2015). https://doi.org/10.1007/s00268-015-3207-1

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  • DOI: https://doi.org/10.1007/s00268-015-3207-1

Keywords

  • Atrial Fibrillation
  • Cholecystitis
  • Acute Appendicitis
  • Medical Complication
  • General Elderly Population