Predictors of Mortality Up to 1 Year After Emergency Major Abdominal Surgery in Older Adults.

Abstract

To identify factors associated with mortality in older adults 30, 180, and 365days after emergency major abdominal surgery. A retrospective study linked to Medicare claims from 2000 to 2010. Health and Retirement Study (HRS). Medicare beneficiaries aged 65.5 enrolled in the HRS from 2000 to 2010 with at least one urgent or emergency major abdominal surgery and a core interview from the HRS within 3years before surgery. Survival analysis was used to describe all-cause mortality 30, 180, and 365days after surgery. Complementary log-log regression was used to identify participant characteristics and postoperative events associated with poorer survival. Four hundred individuals had one of the urgent or emergency surgeries of interest, 24% of whom were aged 85 and older, 50% had coronary artery disease, 48% had cancer, 33% had congestive heart failure, and 37% experienced a postoperative complication. Postoperative mortality was 20% at 30days, 31% at 180days, and 34% at 365days. Of those aged 85 and older, 50% were dead 1year after surgery. After multivariate adjustment including postoperative complications, dementia (hazard ratio (HR)=2.02, 95% confidence interval (CI)=1.24-3.31), hospitalization within 6months before surgery (HR=1.63, 95% CI=1.12-2.28), and complications (HR=3.45, 95% CI=2.32-5.13) were independently associated with worse 1-year survival. Overall mortality is high in many older adults up to 1year after undergoing emergency major abdominal surgery. The occurrence of a complication is the clinical factor most strongly associated with worse survival.