Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery.

Shaheed Merani,Sandy L Widder,Rachel G Khadaroo,Darren Hudson,Raj S Padwal,Judd Payne

doi:10.1186/1749-7922-9-43

Shaheed Merani, Sandy L Widder + Show 4 more

Open Access

https://doi.org/10.1186/1749-7922-9-43

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Abstract

IntroductionWith the increasing aging population demographics and life expectancies the number of very elderly patients (age ≥ 80) undergoing emergency surgery is expected to rise. This investigation examines the outcomes in very elderly patients undergoing emergency general surgery, including predictors of in-hospital mortality and morbidity.MethodsA retrospective study of patients aged 80 and above undergoing emergency surgery between 2008 and 2010 at a tertiary care facility in Canada was conducted. Demographics, comorbidities, surgical indications, and perioperative risk assessment data were collected. Outcomes included length of hospitalization, discharge destination, and in-hospital mortality and morbidity. Multivariable logistic regression was used to identify predictors of in-hospital mortality and complications.ResultsOf the 170 patient admissions, the mean age was 84 years and the in-hospital mortality rate was 14.7%. Comorbidities were present in 91% of this older patient population. Over 60% of the patients required further services or alternate level of care on discharge. American Society of Anesthesiologist Physical Status (ASA) Classification (OR 5.30, 95% CI 1.774-15.817, p = 0.003) and the development of an in-hospital complications (OR 2.51, 95% CI 1.210-5.187, p = 0.013) were independent predictors of postoperative mortality. Chronological age or number of comorbidities was not predictive of surgical outcome.ConclusionsMortality, complication rates and post-discharge care requirements were high in very elderly patients undergoing emergency general surgery. Advanced age and medical comorbidities alone should not be the limiting factors for surgical referral or treatment. This study illustrates the importance of preventing an in-hospital complication in this very vulnerable population. ASA class is a robust tool which is predictive of mortality in the very elderly population and can be used to guide patient and family counseling in the emergency setting.

Highlights

With the increasing aging population demographics and life expectancies the number of very elderly patients undergoing emergency surgery is expected to rise
The purpose of this study is to characterize the very elderly population, who received emergency general surgery, and examine their surgical outcomes including identification of factors associated with in-hospital mortality and morbidity
Materials & methods A retrospective cohort study was conducted on very elderly patients undergoing emergency general surgery at the University of Alberta Hospital, a tertiary care academic teaching hospital in Edmonton, Alberta, Canada between 2008 and 2010

Summary

Introduction

With the increasing aging population demographics and life expectancies the number of very elderly patients (age ≥ 80) undergoing emergency surgery is expected to rise This investigation examines the outcomes in very elderly patients undergoing emergency general surgery, including predictors of in-hospital mortality and morbidity. It is estimated that the majority of people born in developed nations during the 21st century will live to their 100th birthdays [1]. Both the increased number of elderly and the inherent complexity of their health have resulted in increased demands on the health care system [1,2,3,4,5]. Neither a single definition nor measure of frailty exists; there is consensus that very elderly individuals have an increased risk of adverse outcomes from physiological stress and disease

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