Key result
Emergency surgery in older patients hospitalized with an acute abdomen was associated with a significantly increased odds of prolonged hospitalization (aOR 6.60) compared to non-surgical management.
Why the study?
The impact of surgical operation compared to non-surgical management on older patients presenting as general surgical patients is less well researched.
Does emergency surgery improve mortality, length of stay, or readmission in older patients hospitalized with an acute abdomen compared to non-surgical management?
Cohort (n=727)
Yes
Does emergency surgery improve mortality, length of stay, or readmission in older patients hospitalized with an acute abdomen compared to non-surgical management?
In older patients presenting with an acute abdomen, emergency surgery is associated with significantly prolonged hospitalization compared to non-surgical management, without a significant difference in 30- or 90-day mortality.
Answers are grounded in this paper and cite their sources.
Individualized decisions remain essential for elderly emergency general surgery patients; leaves open optimal strategies pending prospective trials.
Background: The impact of surgical operation on older people presenting as general surgical patients compared to non-surgical management is less well researched. Methods: We examined the association between management and adverse outcomes in a cohort of emergency general surgery patients aged>65 years. This multi-center study included 727 patients (mean+/-SD, 77.1±8.2 years, 54% female) admitted to five UK hospitals. Data were analyzed using multi-level crude and multivariable logistic regression. Outcomes included: mortality at Day 30 and 90, length of stay, and readmission within 30 days of discharge. Covariates assessed were management approach, age, sex, frailty, polypharmacy, anemia, and hypoalbuminemia. Results: Approximately 25% of participants (n=185) underwent emergency surgery. Frailty and albumin were associated with mortality at 30 (frailty OR=3.52 [95%CI 1.66-7.49], albumin OR=3.78 ([95%CI 1.53-9.31]), and 90 days post discharge (frailty OR=3.20 [95%CI 1.86-5.51], albumin OR=3.25 [95%CI 1.70-6.19]) and readmission (frailty OR=1.56 [[95%CI (1.04-2.35)]. Surgically managed patients and frailty had increased odds of prolonged hospitalization (surgery OR=5.69 [95%CI 3.67-8.80], frailty OR=2.17 [95%CI 1.46-3.23]). Conclusion: We found the impact of surgery on length of hospitalisation in older surgical patients is substantial. Whether early comprehensive geriatric assessment and post-op rehabilitation would improve this outcome require further evaluation.
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Tay et al. (2020) conducted a cohort in Acute abdomen / Emergency general surgery (n=727). Emergency surgery vs. Non-surgical management was evaluated on Prolonged hospitalization (> 2 weeks) (aOR 6.60, 95% CI 4.13-10.55, p=>0.001). Emergency surgery in older patients hospitalized with an acute abdomen was associated with a significantly increased odds of prolonged hospitalization (aOR 6.60) compared to non-surgical management.
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