Predictors of mortality in elderly patients in emergency abdominal surgery: A retrospective single-center study: Emergency surgery in elderly patients

Mustafa  Altınay; Sibel Oba

doi:10.28982/josam.7972

Authors

Mustafa Altınay Department of Anesthesiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey https://orcid.org/0000-0002-2036-048X
Sibel Oba Department of Anesthesiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey https://orcid.org/0000-0002-5466-1715

DOI:

https://doi.org/10.28982/josam.7972

Keywords:

emergency abdominal surgery, mortality, lactate, c-reactive protein, elderly

Abstract

Background/Aim: Advancements in medical technologies and prolonged life expectancy have increased the number of surgical interventions for elderly patients. Despite this however, emergency surgical interventions remain associated with a high mortality rate. Managing an emergency abdominal surgery in elderly patients poses great challenges for both the surgeon and the anesthesiologist. However, knowing the risk factors that increase mortality may offer advantages to the clinician managing the treatment process. There are studies in the literature examining the mortality of emergency surgeries in elderly patients. However, there are very few studies that work with a specific patient group such as abdominal surgery and then analyze laboratory test results. Here, we aimed to identify the risk factors that can be used to predict mortality in elderly patients undergoing emergency abdominal surgery.

Methods: The study was designed retrospectively in a single center; 100 patients over the age of 80 who underwent emergency abdominal surgery were included in the study. The patients were divided into two groups as survivor and non-survivor. Demographic, surgical, and anesthetic characteristics, laboratory tests, American Society of Anesthesiologists (ASA) physical status scores, postoperative intensive care needs, and treatments of the groups were compared using the chi-squared and Mann Whitney U-test. Determining factors were investigated with logistic regression analysis.

Results: In multivariate analysis, ASA 3 and major surgery significantly increased mortality (P=0.041, P=0.011). Receiver operating characteristic (ROC) curve analysis showed that C-reactive protein with a cut-off value of >84 mg/L had a sensitivity of 58.8% and a specificity of 71.2% (AUC=0.636, P=0.004), while lactate with a cut-off value of >3.6 mmol/L had a sensitivity of 50% and a specificity of 95.5% in predicting mortality (AUC=0.776, P<0.001).

Conclusion: The magnitude of surgery and the ASA score were the best predictors of mortality in elderly patients undergoing emergency abdominal surgery.

Downloads

Download data is not yet available.

References

Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, et al. Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg. 2018;84(6):864-75. DOI: https://doi.org/10.1097/TA.0000000000001829

Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A. National Hospital Discharge Survey: 2007 summary. National health statistics reports. 2010;(29):1–24.

Ingraham AM, Cohen ME, Bilimoria KY, Raval MV, Ko CY, Nathens AB, et al. Comparison of 30-day outcomes after emergency general surgery procedures: potential for targeted improvement. Surgery. 2010;148(2):217–38. DOI: https://doi.org/10.1016/j.surg.2010.05.009

Campbell AJ, Buchner DM. Unstable disability and the fluctuations of frailty. Age and ageing. 1997;26(4):315–8. DOI: https://doi.org/10.1093/ageing/26.4.315

Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. DOI: https://doi.org/10.1186/s12877-016-0329-8

Desserud KF, Veen T, Søreide K. Emergency general surgery in the geriatric patient. Br J Surg. 2016;103(2):e52-61. DOI: https://doi.org/10.1002/bjs.10044

Rubin DS, Huisingh-Scheetz M, Ferguson MK, Nagele P, Peden CJ, Lauderdale DS. U.S. trends in elective and emergent major abdominal surgical procedures from 2002 to 2014 in older adults. J Am Geriatr Soc. 2021;69(8):2220-30. DOI: https://doi.org/10.1111/jgs.17189

Duron JJ, Duron E, Dugue T, Pujol J, Muscari F, Collet D, et al. Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg. 2011;254(2):375-82. DOI: https://doi.org/10.1097/SLA.0b013e318226a959

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ (Clinical research ed.). 2017;335(7624):806–8. DOI: https://doi.org/10.1136/bmj.39335.541782.AD

Svenningsen P, Manoharan T, Foss NB, Lauritsen ML, Bay-Nielsen M. Increased mortality in the elderly after emergency abdominal surgery. Danish medical journal. 2014;61(7):A4876.

Arenal JJ, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg. 2003;46(2):111-6.

Copeland GP. The POSSUM system of surgical audit. Archives of surgery (Chicago, Ill. : 1960). 2002;137(1):15–9. doi: 10.1001/archsurg.137.1.15 DOI: https://doi.org/10.1001/archsurg.137.1.15

Doyle DJ, Hendrix JM, Garmon EH. American Society of Anesthesiologists Classification. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 4, 2023

Haga Y, Ikei S, Ogawa M. Estimation of Physiologic Ability and Surgical Stress (E-PASS) as a new prediction scoring system for postoperative morbidity and mortality following elective gastrointestinal surgery. Surg Today. 1999;29(3):219-25. DOI: https://doi.org/10.1007/BF02483010

Merani S, Payne J, Padwal RS, Hudson D, Widder SL, Khadaroo RG. Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World J Emerg Surg. 2014;9:43. DOI: https://doi.org/10.1186/1749-7922-9-43

Bolger JC, Zaidi A, Fuentes-Bonachera A, Kelly ME, Abbas A, Rogers A, et al. Emergency surgery in octogenarians: Outcomes and factors affecting mortality in the general hospital setting. Geriatrics & gerontology international. 2018;18(8):1211–4. DOI: https://doi.org/10.1111/ggi.13456

Adeva-Andany M, López-Ojén M, Funcasta-Calderón R, et al. Comprehensive review on lactate metabolism in human health. Mitochondrion. 2014;17:76-100. DOI: https://doi.org/10.1016/j.mito.2014.05.007

Black S, Kushner I, Samols D. C-reactive Protein. J Biol Chem. 2004;279(47):48487-90. doi:10.1074/jbc.R400025200 DOI: https://doi.org/10.1074/jbc.R400025200

Fukuda N, Wada J, Niki M, Sugiyama Y, Mushiake H. Factors predicting mortality in emergency abdominal surgery in the elderly. World J Emerg Surg. 2012;7(1):12. DOI: https://doi.org/10.1186/1749-7922-7-12