Key result
Age ≥80 years was not associated with increased mortality or morbidity compared to age 65-79 years in patients undergoing emergency digestive surgery, with an overall 90-day mortality of 23.2%.
Why the study?
Does age ≥80 years increase mortality and morbidity in patients undergoing emergency digestive surgery compared to those aged 65-79 years?
Observational (n=185)
No
Does age ≥80 years increase mortality and morbidity in patients undergoing emergency digestive surgery compared to those aged 65-79 years?
Chronological age ≥80 years alone is not a predictor of mortality or morbidity in emergency digestive surgery; physiological status and comorbidities are more important determinants of outcomes.
Age alone should not preclude emergency digestive surgery; leaves open frailty-based risk stratification in prospective studies.
BACKGROUND: Emergency digestive surgery is being increasingly performed in elderly patients. The aim of the present study was to identify the predictors of mortality and morbidity following emergency digestive surgery in patients aged 80 years and older. METHODS: A single-center retrospective review was performed of consecutive patients aged ≥65 years operated for a digestive surgical emergency between January 2011 and December 2013. Two groups were compared: group A (aged 65-79 years) and group B (aged ≥80 years). RESULTS: The study population included 185 patients: 76 patients in group A and 109 in group B. The mean age was 79.9 years (65-104 years). The overall 90-day mortality rate was 23.2 and 31.9% at 1 year, which was similar between groups. The overall morbidity was 28.6%. No differences were noted between the two groups in overall, minor (Dindo I-II) or major (Dindo III-IV) morbidity rates. Multivariate analysis identified pulmonary disease (odds ratio, OR = 6.43, p = 0.02), bowel ischemia (OR = 11.41, p = 0.01), postoperative ICU stay (OR = 7.37, p < 0.0001) and the occurrence of postoperative complications (OR = 2.66, p = 0.03) as predictors of 90-day mortality. Predictors of in-hospital morbidity were preoperative hemoglobin <12 g/dL (OR = 2.49, p = 0.02) and postoperative intensive care unit (ICU) stay (OR = 6.69, p < 0.0001). An age ≥80 year was not associated with mortality or morbidity in this study. CONCLUSIONS: The decision to perform abdominal surgery in the emergency setting should be based on physiological status, which accounts for a patient's comorbidities and health status, rather than on chronological age per se.
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Hentati et al. (2017) conducted an observational in Digestive surgical emergencies (n=185). Age ≥80 years vs. Age 65-79 years was evaluated on 90-day mortality. Age ≥80 years was not associated with increased mortality or morbidity compared to age 65-79 years in patients undergoing emergency digestive surgery, with an overall 90-day mortality of 23.2%.
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