Increased mortality in the elderly after emergency abdominal surgery

TY - JOUR

T1 - Increased mortality in the elderly after emergency abdominal surgery

AU - Svenningsen, Peter

AU - Manoharan, Thukirtha

AU - Foss, Nicolai B

AU - Lauritsen, Morten

AU - Bay-Nielsen, Morten

PY - 2014/7

Y1 - 2014/7

N2 - INTRODUCTION: The purpose of this study was to evaluate the relation between preoperative delay and mortality in surgical patients undergoing primary emergency laparotomy (PEL) in an unselected, well-described patient cohort in a university hospital setting. MATERIAL AND METHODS: This study was a retrospective analysis of patient charts and perioperative documentation in an unselected consecutive cohort of 131 patients. Covariates for survival outcomes were evaluated in a multivariate analysis. No external funding and no competing interests were declared. The study was approved by The Danish Data Protection Agency; and in pursuance of national Danish research guidelines concerning retrospective studies, approval from ethics committee was not relevant. RESULTS: PEL was performed in 131 patients in the observation period. The median age of the patients was 68 years. The median time from admission to start of operation for all patients was 9.5 hours. No association between a time to operation exceeding six hours and post-operative mortality was found (adjusted odds ratio (95% confidence interval) = 0.67 (0.25-1.78)). Patients over 75 years of age had a very high mortality (47.8%). Most patients died within 30 days post-operatively. CONCLUSION: Acute admission and emergency laparotomy is associated with a very high mortality, especially in elderly patients. However, delay in the surgical treatment exceeding six hours is not associated with a higher mortality. There may be a considerable potential for improving care and management in these patients through a more systematic approach. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

AB - INTRODUCTION: The purpose of this study was to evaluate the relation between preoperative delay and mortality in surgical patients undergoing primary emergency laparotomy (PEL) in an unselected, well-described patient cohort in a university hospital setting. MATERIAL AND METHODS: This study was a retrospective analysis of patient charts and perioperative documentation in an unselected consecutive cohort of 131 patients. Covariates for survival outcomes were evaluated in a multivariate analysis. No external funding and no competing interests were declared. The study was approved by The Danish Data Protection Agency; and in pursuance of national Danish research guidelines concerning retrospective studies, approval from ethics committee was not relevant. RESULTS: PEL was performed in 131 patients in the observation period. The median age of the patients was 68 years. The median time from admission to start of operation for all patients was 9.5 hours. No association between a time to operation exceeding six hours and post-operative mortality was found (adjusted odds ratio (95% confidence interval) = 0.67 (0.25-1.78)). Patients over 75 years of age had a very high mortality (47.8%). Most patients died within 30 days post-operatively. CONCLUSION: Acute admission and emergency laparotomy is associated with a very high mortality, especially in elderly patients. However, delay in the surgical treatment exceeding six hours is not associated with a higher mortality. There may be a considerable potential for improving care and management in these patients through a more systematic approach. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

KW - Abdomen

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Emergencies

KW - Female

KW - Humans

KW - Intestinal Obstruction

KW - Intestinal Perforation

KW - Male

KW - Middle Aged

KW - Postoperative Period

KW - Retrospective Studies

KW - Time-to-Treatment

KW - Young Adult

M3 - Journal article

C2 - 25123123

SN - 1603-9629

VL - 61

SP - 1

EP - 4

JO - Danish Medical Journal

JF - Danish Medical Journal

IS - 7

M1 - A4876

ER -