Abstract
The number of elderly is growing faster than any other age group; this is a global demographic phenomenon and it has important healthcare implications.
The elderly with surgical pathology are more likely to be admitted to hospital as emergency rather than elective and with a wide range of pre-existing medical conditions. In GES, this often dual problem of the surgical and medical condition opens the door to complex post-operative complications.
Half of the emergency laparotomies performed are on elderly patients and have a mortality of 20% at 30 days and 24.4% in patients aged 80 or over, with post-operative ileus and delirium among the most common complications.
The need to improve emergency surgery (ES) outcomes has been highlighted through several national reports and guidance documents from lead bodies in the UK in the last two decades.
GES patients require a tailored and proactive approach that might be summarized into four main areas: preoperative; surgical decision making; post-operative; infrastructure and staffing.
In the context of ES as a ‘sub-specialty status’ inside General Surgery, GES has to be an area of interest, eventually organized into future special units, in order to deliver optimum care for this patient group.
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References
United Nations, Department of Economic and Social Affairs, Population Division. World population ageing. 2015 (ST/ESA/SER.A/390).
Proposed working definition of an older person in Africa for the MDS project. http://www.who.int/healthinfo/survey/ageingdefnolder/en/
The 2018 ageing report: underlying assumptions and projection methodologies. European Commission Directorate-General for Economic and Financial Affairs.
Hewitt J, McCormack C, Tay HS, et al. Prevalence of multimorbidity and its association with outcomes in older emergency general surgical patients: an observational study. BMJ Open. 2016;6:e010126.
National Confidential Enquiry into Patient Outcome and Death (NCEPOD). An age old problem: a review of the care received by elderly patients undergoing surgery. 2010.
Torrance ADW, Powell SL, Griffiths EA. Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med. 2015;7:55–68.
NELA Project Team. Third patient report of the National Emergency Laparotomy Audit RCoA London. 2017.
Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ. Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. Br J Anaesth (England). 2012;109:368–75.
Moug SJ, Stechman M, McCarthy K, Pearce L, Myint PK, Hewitt J. Frailty and cognitive impairment: unique challenges in the older emergency surgical patient. Ann R Coll Surg Engl. 2016;98(3):165–9.
Joseph B, Zangbar B, Pandit V, Fain M, Mohler MJ, Kulvatunyou N, et al. Emergency general surgery in the elderly: too old or too frail? J Am Coll Surg. 2016;222(5):805–13.
Hewitt J, Williams M, Pearce L, et al. The prevalence of cognitive impairment in emergency general surgery. Int J Surg. 2014;12:1031–5.
Nuffield Trust (Commissioned by Royal College of Surgeons). Emergency general surgery: challenges and opportunities. 2016.
Association of coloproctology of GB and Ireland/Association of UGI surgeons and association of surgeons of GB and Ireland. The future of emergency general surgery: a joint document. 2015.
The Royal College of Surgeons. Emergency surgery policy briefing. 2014.
Bagnall NM, Malietzis G, Kennedy RH, Athanasiou T, Faiz O, Darzi A. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Color Dis. 2014;16:947–56.
Paduraru M, Ponchietti L, Casas IM, Svenningsen P, Zago M. Enhanced recovery after emergency surgery: a systematic review. Bull Emerg Trauma. 2017;5(2):70–8.
Paduraru M, Ponchietti L, Casas IM, Svenningsen P, Pereira J, Landaluce-Olavarria A, et al. Enhanced recovery after surgery (ERAS)—the evidence in geriatric emergency surgery: a systematic review. Chirurgia (Bucur). 2017;112(5):546–57.
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;41:402–9. https://doi.org/10.1007/s00268-016-3751-3.
American Geriatrics Society. Clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc. 2015;63(1):142–50.
Parés D, Fernandez-Llamazares J. Unidades funcionales para el manejo quirurgico del paciente geriá trico. Cir Esp. 2018;96:129–30.
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© 2020 World Society of Emergency Surgery and Donegal Clinical and Research Academy
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Paduraru, M. (2020). Optimal Care in Geriatric Emergency Surgery (GES). In: Sugrue, M., Maier, R., Moore, E.E., Catena, F., Coccolini, F., Kluger, Y. (eds) Resources for Optimal Care of Emergency Surgery. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-49363-9_3
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