Display options
Cite
Portinari M, Bianchi L, De Troia A, et al. Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study. Eur J Trauma Emerg Surg. 2021;doi: 10.1007/s00068-021-01646-8.
Portinari, M., Bianchi, L., De Troia, A., Valpiani, G., Spadaro, S., Fogagnolo, A., Acciarri, P., Soliani, G., & Carcoforo, P. (2021). Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study. European journal of trauma and emergency surgery : official publication of the European Trauma Society, . https://doi.org/10.1007/s00068-021-01646-8
Portinari, Mattia, et al. "Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study." European journal of trauma and emergency surgery : official publication of the European Trauma Society vol. (2021). doi: https://doi.org/10.1007/s00068-021-01646-8
Portinari M, Bianchi L, De Troia A, Valpiani G, Spadaro S, Fogagnolo A, Acciarri P, Soliani G, Carcoforo P. Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study. Eur J Trauma Emerg Surg. 2021 Mar 19; doi: 10.1007/s00068-021-01646-8. Epub 2021 Mar 19. PMID: 33742224.
Copy Download .nbib Format: NLM
Share it on

Eur J Trauma Emerg Surg. 2021 Mar 19; doi: 10.1007/s00068-021-01646-8. Epub 2021 Mar 19.

Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study.

European journal of trauma and emergency surgery : official publication of the European Trauma Society

Mattia Portinari, Lara Bianchi, Alessandro De Troia, Giorgia Valpiani, Savino Spadaro, Alberto Fogagnolo, Pierfilippo Acciarri, Giorgio Soliani, Paolo Carcoforo

Affiliations

  1. Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy. [email protected].
  2. Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italia. [email protected].
  3. Dipartimento Chirurgico, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna di Ferrara, Via Aldo Moro, 8 | Stanza 2 34 39 (1C2), 44124, Ferrara, Cona, Italia. [email protected].
  4. Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy.
  5. Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy.
  6. Research Innovation Quality and Accreditation Unit, University Hospital of Ferrara, Ferrara, Italy.
  7. Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesiology and Intensive Care, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy.
  8. Department of Surgery, Unit of Vascular Surgery, University Hospital of Ferrara, Ferrara, Italy.

PMID: 33742224 DOI: 10.1007/s00068-021-01646-8

Abstract

PURPOSE: The primary aim of this study was to evaluate the 30-day survival of nonagenarian patients who underwent non-traumatic emergency abdominal surgery. Other aims were: 90-day and 12-month survival rates, the postoperative complications rate, the impact of the emergency operation on postoperative functional status, the accuracy of the P-POSSUM in predicting 30-day postoperative mortality and changes in care services after surgery.

METHODS: This was a retrospective cohort study of nonagenarian patients who underwent non-traumatic emergency abdominal surgery between January 2010 and June 2017. Patients were divided in two groups according to the 30-day survival status to compare the distribution of patients' characteristics and postoperative outcomes. Overall survival was estimated using the Kaplan-Meier method. To assess the accuracy of P-POSSUM to predict 30-day mortality, a receiver operating characteristic curve and the Hosmer-Lemeshow goodness of fit test were used.

RESULTS: 85 nonagenarian patients were enrolled in this study; of these, 27 (31.8%) died within 30 days. The Kaplan-Meier curve showed a rapid decline in survival over the first 30 postoperative days, followed by a more gradual reduction during the rest of the first year. The majority of patients (92.6%) who died within 30 days experienced a medical complication, with a preponderance of respiratory failure (48.2%) and multiple organ failure (33.3%). In the surviving patients, the postoperative functional status had worsened, and 64.2% of patients did not return to their original housing situation or were institutionalized. The accuracy of P-POSSUM in predicting 30-day mortality in nonagenarian patients was poor.

CONCLUSIONS: This study may help doctors convey the postoperative risks of morbidity and mortality, and also to adequately inform relatives about the possible adverse discharge destination of surviving nonagenarian patients with a consequent increase in care needs.

Keywords: 90–99; Activities of daily living; Aged; Emergency treatment; General surgery; Postoperative complications; Recovery of function; Survival analysis

References

  1. Kotzeva M. Demographic changes—profile of the population. In: Kotzeva M, editor. People in the EU: who are we and how do we live? Luxembourg: Publications Office of the European Union; 2015. p. 21–42. - PubMed
  2. Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865–77. https://doi.org/10.1016/j.jamcollsurg.2006.08.026 . - PubMed
  3. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56. https://doi.org/10.1093/gerona/56.3.m146 . - PubMed
  4. Pelavski AD, De Miguel M, Rochera MI, Lacasta A, Roca M. Immediate postoperative and mid-term survival in nonagenarians undergoing non-traumatic emergency surgery. Minerva Anestesiol. 2014;80(7):796–804. - PubMed
  5. Whiteley MS, Prytherch DR, Higgins B, Weaver PC, Prout WG. An evaluation of the POSSUM surgical scoring system. Br J Surg. 1996;83(6):812–5. - PubMed
  6. Oliver CM, Walker E, Giannaris S, Grocott MP, Moonesinghe SR. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. Br J Anaesth. 2015;115(6):849–60. https://doi.org/10.1093/bja/aev350 . - PubMed
  7. Loc PTB, du Montcel ST, Duron JJ, Levard H, Suc B, Descottes B, et al. Elderly POSSUM, a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients. Br J Surg. 2010;97(3):396–403. https://doi.org/10.1002/bjs.6903 . - PubMed
  8. Gomes A, Rocha R, Marinho R, Sousa M, Pignatelli N, Carneiro C, et al. Colorectal surgical mortality and morbidity in elderly patients: comparison of POSSUM, P-POSSUM, CR-POSSUM, and CR-BHOM. Int J Colorectal Dis. 2015;30(2):173–9. https://doi.org/10.1007/s00384-014-2071-z . - PubMed
  9. Lawrence VA, Hazuda HP, Cornell JE, Pederson T, Bradshaw PT, Mulrow CD, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004;199(5):762–72. https://doi.org/10.1016/j.jamcollsurg.2004.05.280 . - PubMed
  10. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2 . - PubMed
  11. Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10(1):20–30. - PubMed
  12. Newgard CD, Lewis RJ. Missing data: how to best account for what is not known. JAMA. 2015;314(9):940–1. https://doi.org/10.1001/jama.2015.10516 . - PubMed
  13. Racz J, Dubois L, Katchky A, Wall W. Elective and emergency abdominal surgery in patients 90 years of age or older. Can J Surg. 2012;55(5):322–8. https://doi.org/10.1503/cjs.007611 . - PubMed
  14. Aucoin S, McIsaac DI. Emergency general surgery in older adults: a review. Anesthesiol Clin. 2019;37(3):493–505. https://doi.org/10.1016/j.anclin.2019.04.008 . - PubMed
  15. Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM. Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg. 2012;114(3):640–51. https://doi.org/10.1213/ANE.0b013e318240d6eb . - PubMed
  16. Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. 2002;89(4):622–32. https://doi.org/10.1093/bja/aef220 . - PubMed
  17. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–9. https://doi.org/10.1016/s0895-4356(96)00236-3 . - PubMed
  18. Berian JR, Mohanty S, Ko CY, Rosenthal RA, Robinson TN. Association of loss of independence with readmission and death after discharge in older patients after surgical procedures. JAMA Surg. 2016;151(9):e161689. https://doi.org/10.1001/jamasurg.2016.1689 . - PubMed
  19. Sudlow A, Tuffaha H, Stearns AT, Shaikh IA. Outcomes of surgery in patients aged >/=90 years in the general surgical setting. Ann R Coll Surg Engl. 2018;100(3):172–7. https://doi.org/10.1308/rcsann.2017.0203 . - PubMed

Publication Types