Elective and emergency abdominal surgery in patients 90 years of age or olderBackground: Few studies have examined perioperative outcomes in nonagenarians undergoing abdominal surgery, and fewer have reported on 1-year mortality. Our objectives were to determine the outcomes of abdominal surgery in nonagenarians and to assess the performance of Physiologic and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (p-POSSUM) as predictors of mortality. Methods:We conducted a retrospective chart review of all patients 90 years and older who underwent abdominal surgery between 2000 and 2007 at a tertiary care hospital. Results:We included 145 patients (median age 91, range 90-101 yr). The most common diagnoses were colorectal cancer (19.3%) and hernias (19.3%), and the most common procedures were bowel resection with anastomosis (25.5%) and hernia repair (18.6%). Overall in-hospital mortality was 15.2% (20.8% in the emergent group and 9.6% in the elective group; p = 0.06). The 1-year mortality (49.1% v. 27.8%; p = 0.016), complication (81.9% v. 61.6%; p = 0.007) and intensive care unit admission rates (44.4% v. 11.0%; p < 0.001) were significantly higher among emergent than elective surgical patients. The operative indications and procedures associated with the highest in-hospital mortality were large bowel obstruction (42.3%) and bowel resection with anastomosis (27.0%). Both the POSSUM and p-POSSUM scoring systems significantly overpredicted mortality, particularly in higher risk groups. Conclusion:Nonagenarians undergoing abdominal surgery have substantial operative morbidity and mortality, particularly in emergent surgical cases. Nearly 50% of patients who undergo emergency procedures die within 1 year after surgery. The POSSUM and p-POSSUM scoring systems were not reliable predictors of in-hospital mortality.Contexte : Peu d'études se sont penchées sur les résultats périopératoires de la chirurgie abdominale chez les nonagénaires, et moins encore ont mesuré leur mortalité à 1 an. Nous avions pour objectifs de déterminer l'issue de la chirurgie abdominale chez les nonagénaires et de mesurer les indices POSSUM (Physiologic and Operative Severity Score for enUmeration of Mortality and morbidity) et p-POSSUM (Portsmouth-POSSUM) en tant que prédicteurs de la mortalité. Résultats : Nous avons inclus 145 patients (âge médian 91 ans, éventail de 90 à 101 ans). Les diagnostics les plus fréquents étaient le cancer colorectal (19,3 %) et les hernies (19,3 %), tandis que les interventions les plus courantes ont été la résection intestinale avec anastomose (25,5 %) et la réparation de hernie (18,6 %). La mortalité perhospitalière globale a été de 15,2 % (20,8 % dans le groupe ayant subi une intervention d'urgence et de 9,6 % dans le groupe ayant subi une intervention élective; p = 0,06). Les taux à 1 an pour ce qui est de la mortalité (49,1 % c. 27,8 %; p = 0,016), des complications (81,9 % c. 61,6 %; p = 0,007) et des admissions aux unités de soins intensifs (44,4 % c. 11,0 %; ...

High PLR was associated with reduced RFS. The prognostic ability of PLR to predict recurrence suggests that it may play a role in risk-stratification schemes used to determine which patients will benefit from adjuvant therapy.

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