Skip to main content

Advertisement

SpringerLink
Log in

Operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Aim

To evaluate operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients.

Methods

A total of 533 geriatric patients (aged ≥ 65 years, median age: 73.0 years, 50.7% were females) who underwent either elective surgery (n = 285) or emergency surgery (n = 248) were included in this study. Data on patient demographics, co-morbid disorders, type of surgery and anesthesia, American Society of Anesthesiologists (ASA) physical status (PS) classification, length of hospital stay, length of ICU stay, hospitalization outcome, prognosis (survivor, non-survivor) were obtained from medical records.

Results

Emergency surgery group was associated with higher prevalence of ASA-PS III (48.8 vs. 25.6%, p < 0.001) and ASA-PS IV (19.0 vs. 0.4%, p < 0.001) categories and higher mortality rates (20.6 vs. 4.9% vs. p < 0.001) when compared to the elective surgery group. ASA-PS IV category was associated with oldest patient age (median 82.0 vs. 71.0 years for ASA-PS I and II, p < 0.001 for each and versus 75.0 years for ASA-PS III, p < 0.05) and highest mortality rate (35.4 vs. 3.4% for ASA-PS I, 6.0% for ASA-PS II and 16.5% for ASA-PS III, p < 0.001) as compared with other categories.

Conclusion

In conclusion, our findings in a retrospective cohort of elderly surgical patients revealed high prevalence of co-morbidities, predominance of ASA-PS II or ASA-PS III classes and an overall in-hospital mortality rate of 12.2%. Emergency as compared with elective surgery seems to be associated with older age, male gender, ASA-PS III and IV classes, higher likelihood of postoperative ICU transfer and higher mortality rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Pearce L, Bunni J, McCarthy K et al (2016) Surgery in the older person: training needs for the provision of multidisciplinary care. Ann R Coll Surg Engl 98:367–370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. McLean RC, McCallum IJ, Dixon S et al (2016) A 15-year retrospective analysis of the epidemiology and outcomes for elderly emergency general surgical admissions in the North East of England: a case for multidisciplinary geriatric input. Int J Surg 28:13–21

    Article  PubMed  Google Scholar 

  3. Benavides-Caro CA (2016) Anestesia y paciente anciano, en busca de mejores desenlaces neurológicos. Rev Colomb Anestesiol 44:128–133

    Article  Google Scholar 

  4. Turrentine FE, Wang H, Simpson VB et al (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203:865–877

    Article  PubMed  Google Scholar 

  5. Klopfenstein CE, Herrmann FR, Michel JP et al (1998) The influence of an aging surgical population on the anesthesia workload: a ten-year survey. Anesth Analg 86:1165–1170

    CAS  PubMed  Google Scholar 

  6. Etzioni DA, Liu JH, Maggard MA et al (2003) The aging population and its impact on the surgery workforce. Ann Surg 238:170–177

    PubMed  PubMed Central  Google Scholar 

  7. Hosking MP, Warner MA, Lobdell CM et al (1989) Outcomes of surgery in patients 90 years of age and older. JAMA 261:1909–1915

    Article  CAS  PubMed  Google Scholar 

  8. Kim KI, Park KH, Koo KH et al (2013) Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery. Arch Gerontol Geriatr 56:507–512

    Article  PubMed  Google Scholar 

  9. Shipway DJ, Partridge JS, Foxton CR et al (2015) Do surgical trainees believe they are adequately trained to manage the ageing population? A UK survey of knowledge and beliefs in surgical trainees. J Surg Educ 72:641–647

    Article  CAS  PubMed  Google Scholar 

  10. Murthy S, Hepner DL, Cooper Z et al (2015) Controversies in anaesthesia for noncardiac surgery in older adults. Br J Anaesth 115:15–25

    Article  Google Scholar 

  11. Glance LG, Osler TM, Neuman MD (2014) Redesigning surgical decision making for high-risk patients. N Engl J Med 370:1379–1381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Merani S, Payne J, Padwal RS et al (2014) Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World J Emerg Surg 9:43

    Article  PubMed  PubMed Central  Google Scholar 

  13. Saklad M (1941) Grading of patients for surgical procedures. Anesthesiologist 2:281–284

    Article  Google Scholar 

  14. Dripps RD (1963) New classification of physical status. Anesthesiologist 24:111

    Google Scholar 

  15. Vilches-Moraga A, Fox J (2018) Geriatricians and the older emergency general surgical patient: proactive assessment and patient centred interventions. Salford-POP-GS. Aging Clin Exp Res. https://doi.org/10.1007/s40520-017-0886-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. Desserud KF, Veen T, Søreide K (2016) Emergency general surgery in the geriatric patient. Br J Surg 103:52–61

    Article  Google Scholar 

  17. Torrance ADW, Powell SL, Griffiths EA (2015) Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med OAEM 7:55–68

    PubMed  Google Scholar 

  18. Khan M, Azim A, O’Keeffe T et al (2018) Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients. Am J Surg 215:53–57

    Article  PubMed  Google Scholar 

  19. Inouye SK (2000) Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. Ann Med 32:257–263

    Article  CAS  PubMed  Google Scholar 

  20. Saleh A, Thirukumaran C, Mesfin A et al (2017) Complications and readmission after lumbar spine surgery in elderly patients: an analysis of 2320 patients. Spine J 17:1106–1112

    Article  PubMed  Google Scholar 

  21. Roy RC (2000) Choosing general versus regional anesthesia for the elderly. Anesthesiol Clin N Am 18:91–104

    Article  CAS  Google Scholar 

  22. Kim S, Brooks AK, Groban L (2014) Preoperative assessment of the older surgical patient: honing in on geriatric syndromes. Clin Interv Aging 10:13–27

    PubMed  PubMed Central  Google Scholar 

  23. Rigg JR, Jamrozik K, Myles PS et al (2002) Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 359:1276–1282

    Article  PubMed  Google Scholar 

  24. Novak-Jankovic V (2013) Regional anaesthesia for the elderly patients. Periodicum Biologorum 115:119–123

    Google Scholar 

  25. Liu JL, Wang XL, Gong MW et al (2014) Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients. Patient Prefer Adherence 8:651–659

    PubMed  PubMed Central  Google Scholar 

  26. Luger TJ, Kammerlander C, Gosch M et al (2010) Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporos Int 21(Suppl 4):555–572

    Article  CAS  Google Scholar 

  27. Harari D, Hopper A, Dhesi J et al (2007) Proactive care of older people undergoing surgery (‘POPS’): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age Ageing 36:190–196

    Article  PubMed  Google Scholar 

  28. Dhesi J (2013) Setting up a proactive service to make surgery safer for older people. The Health Foundation. http://patientsafety.health.org.uk/resources/setting-proactive-service-make-surgery-safer-older-people. Accessed 10 Feb 2018

Download references

Funding

No financial support or funding was received for this paper.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Van Yuzuncu Yil University Medical Faculty, Van, Turkey

    Celaleddin Soyalp, Nureddin Yuzkat, Mehmet Kilic & Nurcin Gulhas

  2. Department of Neurosurgery, Van Yuzuncu Yil University Medical Faculty, Van, Turkey

    Mehmet Edip Akyol

  3. Department of Plastic and Reconstructive Surgery, Van Yuzuncu Yil University Medical Faculty, Van, Turkey

    Canser Yilmaz Demir

Authors
  1. Celaleddin Soyalp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nureddin Yuzkat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet Edip Akyol
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Canser Yilmaz Demir
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nurcin Gulhas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Celaleddin Soyalp.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The design and protocol of this retrospective study were approved by our institutional review board (Date: 19 July 2017, Decision Number: 01).

Informed consent

All patients provided consent for their medical records to be used in a scientific study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soyalp, C., Yuzkat, N., Kilic, M. et al. Operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients. Aging Clin Exp Res 31, 403–410 (2019). https://doi.org/10.1007/s40520-018-0976-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-018-0976-z

Keywords

Search

Navigation