Predictors of mortality in elderly patients in emergency abdominal surgery: A retrospective single-center study
Emergency surgery in elderly patients
Keywords:emergency abdominal surgery, mortality, lactate, c-reactive protein, elderly
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.
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