Hassen Hentati1, Chady Salloum1, Philippe Caillet2,3, Eylon Lahat1, Mara Disabato1, Eric Levesque4,5, Philippe Compagnon1,5, Chetana Lim1, Daniel Azoulay6,7. 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. 2. Department of Internal and Geriatric Medicine, AP-HP Henri-Mondor Hospital, Université Paris Est - UPEC, 94010, Creteil, France. 3. CEpiA (Clinical Epidemiology and Ageing), University Paris-Est Créteil (UPEC) EA 7376- IMRB, Creteil, France. 4. Department of Anaesthesia and Surgical Intensive Care-Liver ICU, AP-HP Henri Mondor Hospital, Université Paris Est - UPEC, 94010, Creteil, France. 5. INSERM, Unit U955, Creteil, France. 6. 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. daniel.azoulay@aphp.fr. 7. INSERM, Unit U955, Creteil, France. daniel.azoulay@aphp.fr.
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.
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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