Background: Over 35 million Americans are at least 65 years old. This population is projected to double in the coming decades and as a result, the number of elderly(age ≧70) who present to the hospital requiring emergency surgery is rising. Emergency surgery is associated with increased morbidity and mortality, and is further magnified among the elderly. The aim of this study was to determine the mortality rates of elderly patients who underwent emergency laparotomy, and to define the variables associated with increased risk of morbidity and mortality, which can be used for quality improvement and informed surgical decision making in the preoperative setting.
Methods: A retrospective cohort study of patients age ≧70 that required emergency abdominal surgery by the Colorectal Surgery Department at a tertiary care center from 1994 to 2004 was conducted. Outcome variables included age, ASA classification, albumin level, diagnosis, co-morbid conditions and APACHE II score. The endpoints of in hospital mortality, length of hospitalization and one-year mortality were examined.
Results: Eighty-eight patients met inclusion criteria for analysis(55F, 33M). The average patient age was 79 years. Initial diagnoses included bowel obstruction, perforated diverticulitis, perforated cancer, ischemic colon and appendicitis. The primary procedures performed included resection with primary anastomosis, Hartman resection, diverting colostomy/ileostomy, appendectomy or lysis of adhesions. There was a 20% in hospital mortality. The 1-year mortality rate was 38%. Univariate analyses were performed on outcome variables. Increased ASA class(p<0.001), length of stay in the SICU(p<0.001), advanced age(p<0.011) and decreased albumin level(p<0.007) were associated with statistically significant increased mortality. There was no statistical difference in mortality based on etiology of abdominal emergency, APACHE II score or co-morbid conditions. However, patients presenting with perforated diverticulitis had an increased hospitalization compared with all other patients (21v.14 days, p<0.03).
Conclusions: Emergency abdominal surgery in the elderly is associated with high 30-day morbidity and mortality. This cohort found an appreciable 1-year mortality (38%). Additionally, this study demonstrated that increased mortality was associated with increased ASA class, advanced age and decreased albumin level. The results of this study illustrate the factors which can augment the preoperative evaluation of elderly patients who present with abdominal emergencies, as well as provide data which can be used to enhance informed decision making between the surgeon and patient.