Key result
Emergency general surgery links to ECOG-PS deterioration in ~46% of patients over 90.
Why the study?
Functional deterioration after emergency general surgery is challenging in super-elderly patients, but limited research has evaluated postoperative performance status deterioration and subsequent recovery.
Does emergency general surgery cause deterioration in postoperative performance status in patients aged over 90 years?
Cohort (n=77)
Does emergency general surgery cause deterioration in postoperative performance status in patients aged over 90 years?
Emergency general surgery in patients over 90 years old causes significant functional deterioration, particularly in those with good preoperative performance status, though most patients and families maintain positive impressions of the surgery.
Background: Functional deterioration following emergency general surgery (EGS) poses a significant challenge in super-elderly patients. However, limited research has focused on assessing the deterioration in postoperative performance status (PS). This study aimed to investigate the impact of EGS on PS deterioration in super-elderly patients, and the extent to which deteriorated PS is recovered. Methods: This historical cohort study comprised 77 super-elderly patients who underwent EGS between July 2015 and December 2020. Functional deterioration was evaluated by comparing preoperative and postoperative Eastern Cooperative Oncology Group Performance Status (ECOG-PS). The Emergency Surgical Score (ESS) was used as a risk-adjustment tool. Questionnaires were mailed to the patients and their families to assess post-discharge PS and obtain their impressions of EGS. Results: Postoperative PS deteriorated in 35/77 patients (45.5 %). Significant differences were observed between the groups in terms of sex, serum C-reactive protein (CRP) levels, ESS scores, preoperative ECOG-PS, duration of operation, and major complications. Multivariate analysis of preoperative factors showed that ESS ≥7 (OR: 3.7, 95 % CI: 1.0-13), preoperative ECOG-PS ≤2 (OR: 5.9, 95 % CI: 1.7-21), and female sex (OR: 5.8, 95 % CI: 1.6-21) were associated with postoperative ECOG-PS deterioration. According to the questionnaire results, PS recovery post-discharge was observed in 6/36 (17 %) patients, and 34/36 (94 %) patients and their families expressed positive impressions of EGS. Conclusions: EGS in super-elderly patients highly caused a deterioration in their PS, particularly in patients with maintained preoperative PS. PS hardly recovered; however, most patients and their families had positive impressions of the EGS. Key message: We assessed the pre- and postoperative performance status of super-elderly patients who underwent emergency general surgery. Surgery caused a marked deterioration in patients' functional performance, which seldom recovered postoperatively.
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Harada et al. (2023) conducted a cohort in Emergency general surgery in super-elderly patients (n=77). Emergency general surgery was evaluated on Postoperative performance status (ECOG-PS) deterioration. Emergency general surgery caused postoperative performance status deterioration in 45.5% of patients aged over 90 years, with preoperative ECOG-PS ≤2 strongly predicting decline (OR 5.9; 95% CI 1.7-21).
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