Key result
Elevated pre-admission ESR links to a ~2-day longer critical care stay after emergency laparotomy.
Why the study?
There is a significant lack of biomarkers to risk-stratify an ageing, frail patient population undergoing emergency laparotomy.
Do pre-morbid inflammatory markers predict adverse outcomes in older adult patients undergoing emergency laparotomy?
Observational (n=196)
No
Do pre-morbid inflammatory markers predict adverse outcomes in older adult patients undergoing emergency laparotomy?
Elevated pre-morbid ESR and lymphocyte count identify older patients at risk for longer critical care stays following emergency laparotomy.
Answers are grounded in this paper and cite their sources.
Pre-admission ESR and LC may aid risk stratification in older emergency laparotomy patients; leaves open whether inflammaging biomarkers improve existing tools.
Surgeons are increasingly faced with an ageing and frail patient population. There is a significant absence of biomarkers capable of risk stratifying patients undergoing emergency laparotomy. Inflammaging describes a state of chronic inflammation associated with ageing and frailty that may predict worse outcomes after surgery. This retrospective observational study evaluated pre-morbid inflammatory markers in the prognostication of older adult patients undergoing emergency laparotomy. Patients aged ≥65 years undergoing surgery between 1 April 2017 and 1 April 2022 were identified. Pre-admission and acute C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total white cell count (WCC), neutrophil count (NC) and lymphocyte count (LC) datapoints were captured. Pre-operative risk stratification scores and post-operative outcomes were recorded using the National Emergency Laparotomy Audit (NELA) database. A cohort of 196 patients was included: 57.7% were female, median age 74.5 years. High risk (NELA risk of mortality ≥ 5%) and frail (clinical frailty scale ≥ 4) patients experienced a significantly longer hospital and critical care stay (p < 0.05). Pre-admission ESR ≥ 16 and LC ≥ 4.1 were significantly associated with a longer critical care stay (p < 0.05); no statistical significance was observed with CRP, WCC and NC in predicting adverse outcomes. We found that an elevated pre-morbid ESR and LC identifies a potential inflammaging cohort that demonstrates worse outcomes following emergency laparotomy. The prognostication of older adult surgical patients remains a challenge and represents an area of research deserving of future attention.
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George et al. (2023) conducted an observational in Emergency laparotomy (n=196). Elevated pre-admission erythrocyte sedimentation rate (ESR ≥ 16) vs. Normal pre-admission erythrocyte sedimentation rate (ESR ≤ 15) was evaluated on Duration of critical care stay (median days) (p=0.012). Elevated pre-admission erythrocyte sedimentation rate (≥16) was significantly associated with a prolonged critical care admission (median 2 days vs 0 days) in older adults undergoing emergency laparotomy.
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