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Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies

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Abstract

Background

Emergency digestive surgery is being increasingly performed in elderly patients. The aim of the present study was to identify the predictors of mortality and morbidity following emergency digestive surgery in patients aged 80 years and older.

Methods

A single-center retrospective review was performed of consecutive patients aged ≥65 years operated for a digestive surgical emergency between January 2011 and December 2013. Two groups were compared: group A (aged 65–79 years) and group B (aged ≥80 years).

Results

The study population included 185 patients: 76 patients in group A and 109 in group B. The mean age was 79.9 years (65–104 years). The overall 90-day mortality rate was 23.2 and 31.9% at 1 year, which was similar between groups. The overall morbidity was 28.6%. No differences were noted between the two groups in overall, minor (Dindo I–II) or major (Dindo III–IV) morbidity rates. Multivariate analysis identified pulmonary disease (odds ratio, OR = 6.43, p = 0.02), bowel ischemia (OR = 11.41, p = 0.01), postoperative ICU stay (OR = 7.37, p < 0.0001) and the occurrence of postoperative complications (OR = 2.66, p = 0.03) as predictors of 90-day mortality. Predictors of in-hospital morbidity were preoperative hemoglobin <12 g/dL (OR = 2.49, p = 0.02) and postoperative intensive care unit (ICU) stay (OR = 6.69, p < 0.0001). An age ≥80 year was not associated with mortality or morbidity in this study.

Conclusions

The decision to perform abdominal surgery in the emergency setting should be based on physiological status, which accounts for a patient’s comorbidities and health status, rather than on chronological age per se.

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Authors and Affiliations

  1. Department of Digestive, Hepato-Bilio-Pancreatic Surgery Unit and Liver Transplantation, AP-HP Henri-Mondor Hospital, Université Paris, Est – UPEC, Est - 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France

    Hassen Hentati, Chady Salloum, Eylon Lahat, Mara Disabato, Philippe Compagnon, Chetana Lim & Daniel Azoulay

  2. Department of Internal and Geriatric Medicine, AP-HP Henri-Mondor Hospital, Université Paris Est – UPEC, 94010, Creteil, France

    Philippe Caillet

  3. CEpiA (Clinical Epidemiology and Ageing), University Paris-Est Créteil (UPEC) EA 7376- IMRB, Creteil, France

    Philippe Caillet

  4. Department of Anaesthesia and Surgical Intensive Care-Liver ICU, AP-HP Henri Mondor Hospital, Université Paris Est – UPEC, 94010, Creteil, France

    Eric Levesque

  5. INSERM, Unit U955, Creteil, France

    Eric Levesque, Philippe Compagnon & Daniel Azoulay

Authors
  1. Hassen Hentati
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  2. Chady Salloum
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  4. Eylon Lahat
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  5. Mara Disabato
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  6. Eric Levesque
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  7. Philippe Compagnon
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  8. Chetana Lim
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  9. Daniel Azoulay
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Correspondence to Daniel Azoulay.

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Hentati, H., Salloum, C., Caillet, P. et al. Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies. World J Surg 42, 1988–1996 (2018). https://doi.org/10.1007/s00268-017-4419-3

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  • DOI: https://doi.org/10.1007/s00268-017-4419-3

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