Delayed surgery (≥2 days) in older adults undergoing emergency general surgery was associated with a shorter postoperative length of stay (ATE -0.45 days; 95% CI -0.70 to -0.21).
Cohort (n=40,502)
Yes
Does delayed time from admission to operation (≥2 days) affect postoperative outcomes differently in older versus younger adults undergoing emergency general surgery?
Delayed emergency general surgery is associated with worse outcomes in younger adults but not older adults, suggesting that preoperative optimization may be a safe and beneficial strategy for the elderly.
Mean Difference: -0.45 (95% CI -0.7–-0.21)
Background: Rising patient volumes and an aging population are leading to difficulties in providing timely surgical intervention in emergency general surgery (EGS). With decreased resilience and greater comorbidity burden, we hypothesized that older adults would be disproportionately affected by longer preoperative wait times compared to younger adults. Study Design: This retrospective cohort study compared older (≥65 years) to younger adults (16–64 years) who were urgently/emergently admitted between 2016-2020 to undergo one of the seven most common EGS operations using the Virginia Health Information Patient Level Database. Propensity score matching (1: 1 nearest neighbor) analyzed the association between delayed time from admission to operation (≥2 days) and the outcomes of postoperative length of stay (POLOS), readmission, inpatient mortality, and total hospital charges, stratifying by older versus younger adults. Controls included demographics, insurance, socioeconomic status, comorbidities, and operative approach. Effect sizes were reported as average treatment effects (ATE) with 95% confidence intervals. Results: Among 40, 502 patients, 14, 779 (36. 5%) were aged ≥65 years. Delayed surgery occurred in 43. 3% of older and 29. 8% of younger adults. After matching, delayed surgery in younger adults was associated with increased readmission (ATE=3. 5% 2. 1–4. 9%) and longer POLOS (ATE=0. 26 days 0. 05–0. 47). Conversely, delayed surgery in older adults was not associated with readmission (ATE=-0. 1% -1. 7–1. 4%) and linked to shorter POLOS (ATE=-0. 45 days -0. 70 – -0. 21). Both age groups experienced similar increases in hospital charges (ATE ≈ 13, 500), and mortality was not associated with surgical timing. Conclusions: Contrary to our hypothesis, delayed surgery was associated with worse outcomes for younger but not older adults. These findings challenge the prevailing urgency paradigm in EGS and suggest that preoperative optimization may mitigate risks in older adults.
Rice et al. (2026) conducted a cohort in Emergency general surgery (n=40,502). Delayed surgery (≥2 days from admission to operation) vs. Early surgery (<2 days) was evaluated on Postoperative length of stay (POLOS) in older adults (≥65 years) (ATE -0.45 days, 95% CI -0.70 to -0.21). Delayed surgery (≥2 days) in older adults undergoing emergency general surgery was associated with a shorter postoperative length of stay (ATE -0.45 days; 95% CI -0.70 to -0.21).