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.
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.
Odds Ratio: 6.6 (95% CI 4.13–10.55)
Absolute Event Rate: 35.1% vs 9%
p-value: p=>0.001
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. Keywords: acute surgery, length of stay, mortality, older patients, operation, readmission
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.