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Am J Surg. 2019 Aug;218(2):248-254. doi: 10.1016/j.amjsurg.2018.11.023. Epub 2018 Nov 27.

Outcomes of emergency abdominal surgery in octogenarians: A single-center analysis.

Author information

1
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
2
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: beat.schnuriger@gmail.com.

Abstract

BACKGROUND:

The aim of this study was to assess outcomes of octogenarians undergoing emergency abdominal surgery (EAS).

METHODS:

Octogenarians undergoing EAS 12/2011-12/2016 were retrospectively analysed. The outcomes were assessed by univariable and multivariable regression analysis.

RESULTS:

One-hundred-forty patients with a median age of 83.9 years were included. EAS was performed for cholecystitis (27.1%), ileus (22.1%), hollow viscus perforation (16.4%), diverticulitis (12.9%), mesenteric ischemia (10.0%), incarcerated hernia (9.3%), and appendicitis (2.1%). The overall and early (within 7 days from surgery) mortality rate was 16.4% and 10.0%, respectively. Multivariable analysis revealed age (OR 1.24,CI95% 1.04-1.47,p = 0.015), ASA scores≥4 (OR 11.15,CI95% 2.39-52.02,p = 0.002), mesenteric ischemia (OR 52.60,CI95% 8.93-309.94,p < 0.001) and ICU admission (OR 9.23,CI95% 1.74-49.04,p = 0.009) as independent predictors for mortality. Postoperative withdrawal of care accounted for 36% of early mortalities.

CONCLUSIONS:

One third of early mortality in octogenarians was due to postoperative withdrawal of care. An interdisciplinary decision-making including patients' and relatives' wishes may avoid ethically questionable interventions in octogenarians.

KEYWORDS:

Early mortality; Emergency abdominal surgery; Loss of independency; Mortality; Octogenarians

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