Adil A Shah1, Syed Nabeel Zafar2, Lisa M Kodadek3, Cheryl K Zogg4, Alyssa B Chapital5, Aftab Iqbal2, Wendy R Greene2, Edward E Cornwell2, Joaquim Havens4, Stephanie Nitzschke4, Zara Cooper4, Ali Salim4, Adil H Haider6. 1. Division of General Surgery, Department of Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Brigham & Women's Hospital, Boston, MA, USA. 2. Department of Surgery, Howard University College of Medicine, Washington, DC, USA. 3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 4. Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Brigham & Women's Hospital, Boston, MA, USA. 5. Division of General Surgery, Department of Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA. 6. Division of General Surgery, Department of Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA. Electronic address: ahhaider@partners.org.
Abstract
BACKGROUND: Aging of the population necessitates consideration of the increasing number of older adults requiring emergency care. The objective of this study was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery (EGS) patients with younger adults. METHODS: Based on a standardized definition of EGS, patients in the 2007 to 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample were queried for primary EGS diagnoses. Included patients were categorized into older (≥80 years) vs younger (<80 years) adults based on a marked increase in mortality around aged 80 years. Using propensity scores, risk-adjusted differences in major morbidity, mortality, length of stay (LOS), and cost were compared. RESULTS: Of 3,707,465 included patients, 17.2% (n = 637,588) were ≥80 years. Relative to younger adults, older patients most frequently presented for gastrointestinal-bleeding (odds ratio [95% confidence intervals]: 2.81 [2.79 to 2.82]) and gastrostomy care (2.46 [2.39 to 2.53]). Despite higher odds of mortality (1.67 [1.63 to 1.69]), older adults exhibited lower risk-adjusted odds of morbidity (.87 [.86 to .88]), shorter LOS (4.50 vs 5.14 days), and lower total hospital costs ($10,700 vs $12,500). CONCLUSIONS: Octogenarian and/or nonagenarian patients present differently than younger adults. Reductions in complications, LOS, and cost among surviving older adults allude to a "survivorship tendency" to never give up, despite collectively higher mortality risk.
BACKGROUND: Aging of the population necessitates consideration of the increasing number of older adults requiring emergency care. The objective of this study was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery (EGS) patients with younger adults. METHODS: Based on a standardized definition of EGS, patients in the 2007 to 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample were queried for primary EGS diagnoses. Included patients were categorized into older (≥80 years) vs younger (<80 years) adults based on a marked increase in mortality around aged 80 years. Using propensity scores, risk-adjusted differences in major morbidity, mortality, length of stay (LOS), and cost were compared. RESULTS: Of 3,707,465 included patients, 17.2% (n = 637,588) were ≥80 years. Relative to younger adults, older patients most frequently presented for gastrointestinal-bleeding (odds ratio [95% confidence intervals]: 2.81 [2.79 to 2.82]) and gastrostomy care (2.46 [2.39 to 2.53]). Despite higher odds of mortality (1.67 [1.63 to 1.69]), older adults exhibited lower risk-adjusted odds of morbidity (.87 [.86 to .88]), shorter LOS (4.50 vs 5.14 days), and lower total hospital costs ($10,700 vs $12,500). CONCLUSIONS: Octogenarian and/or nonagenarian patients present differently than younger adults. Reductions in complications, LOS, and cost among surviving older adults allude to a "survivorship tendency" to never give up, despite collectively higher mortality risk.
Authors: Matteo Novello; Davide Gori; Salomone Di Saverio; Matteo Bianchin; Lorenzo Maestri; Francesco Vito Mandarino; Giuseppe Cavallari; Bruno Nardo Journal: World J Surg Date: 2018-01 Impact factor: 3.352
Authors: Cheryl K Zogg; Wei Jiang; Taylor D Ottesen; Shahid Shafi; Kevin Schuster; Robert Becher; Kimberly A Davis; Adil H Haider Journal: Ann Surg Date: 2018-12 Impact factor: 12.969
Authors: Jason W Smith; Jennifer Knight Davis; Catherine C Quatman-Yates; Brittany L Waterman; Scott A Strassels; Jen D Wong; Victor K Heh; Holly E Baselice; Guy N Brock; Brian C Clark; John F P Bridges; Heena P Santry Journal: J Am Geriatr Soc Date: 2019-07-13 Impact factor: 5.562