Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors

Abstract

Background: In the United States, ileus accounts for USD 750 million of healthcare expenditures annually and significantly contributes to morbidity and mortality. Despite its significance, the complete picture of mortality risk factors for these patients have yet to be fully elucidated; therefore, the aim of this study is to identify mortality risk factors in patients emergently admitted with paralytic ileus. Methods: Adult and elderly patients emergently admitted with paralytic ileus between 2005–2014 were investigated using the National Inpatient Sample Database. Clinical outcomes, therapeutic management, demographics and comorbidities were collected. Associations between mortality and all other variables were established via univariable and multivariable logistic regression models. Results: A total of 81,674 patients were included, of which 45.2% were adults, 54.8% elderly patients, 45.8% male and 54.2% female. The average adult and elderly ages were 48.3 and 78.8 years, respectively. Elderly patients displayed a significantly (p < 0.01) higher mortality rate (3.0%) than adults (0.7%). The final multivariable logistic regression model showed that for every one-day delay in operation, the odds of mortality for adult and elderly patients increased by 4.1% (p = 0.002) and 3.2% (p = 0.014), respectively. Every additional year of age corresponded to 3.8% and 2.6% increases in mortality for operatively managed adult (p = 0.026) and elderly (p = 0.015) patients. Similarly, non-operatively treated adult and elderly patients displayed associations between mortality and advanced age (p = 0.001). The modified frailty index exhibited associations with mortality in operatively treated adults, conservatively managed adults and conservatively managed elderly patients (p = 0.001). Every additional day of hospitalization increased the odds of mortality in non-operative adult and elderly patients by 7.6% and 5.8%, respectively. Female sex correlated to lower mortality rates in non-operatively managed adult patients (odds ratio = 0.71, p = 0.028). Undergoing invasive diagnostic procedures in non-operatively managed elderly patients related to reduced mortality (odds ratio = 0.78, p = 0.026). Conclusions: Patients emergently admitted for paralytic ileus with increased hospital length of stay, longer time to operation, advanced age or higher modified frailty index displayed higher mortality rates. Female sex and invasive diagnostic procedures were negatively correlated with death in nonoperatively managed patients with paralytic ileus.

Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients

“…This helps explain our findings that adult non-operative patients may be considered higher risk, based on the presence of more comorbidities, and their vulnerability to additional days in the hospital. Interestingly, our study did not find time to operation to be a risk factor for mortality, contrary to other studies where an increased time to operation increased the odd of mortality [ 13 , 25 , 34 , 35 , 38 , 40 ]. While there is ample literature studying the different surgical methods for umbilical hernia repair, there is clearly a need to further investigate the impact of delaying surgery, HLOS, and the non-operative “watchful waiting” approach on the mortality of patients with UH.…”

“…Specifically, there was a 7.7% increase in the odds of mortality for each additional day spent in the hospital. Similarly, associations between mortality and HLOS were noted in multiple recent retrospective studies on patients emergently admitted with gastroparesis, hemorrhoids, duodenal ulcers, blunt chest wall trauma, tracheostomy, rectal malignancy, total hip arthroplasty, and paralytic ileus [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. The HLOS was not a significant predictor for mortality in the elderly sample, despite elderly patients experiencing a longer HLOS ( Table 2 ).…”

Risk Factors for Postoperative Ileus Following Spine Surgery: A Systematic Review With Meta-Analysis

“… 4 , 8 , 9 One of the most discussed patient characteristics related to risk of developing POI in the literature is age. 38 Although GI function and bowel motility decline with age, 15 our analysis showed that age did not contribute to the development of POI. As spinal procedures are more commonly performed in the elderly because of the higher prevalence of degenerative diseases, 39 it is reasonable that the age distribution of patients in the POI and non-POI groups would be similar, leading to no statistical difference.…”

Elderly Patients Managed Non-Operatively with Abscesses of the Anorectal Region Have Five Times Higher Rate of Mortality Compared to Non-Elderly

“…Longer hospital length of stay has been shown to be detrimental in many diverse conditions [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 30 , 33 , 34 ]. Interestingly, for patients with ruptured abdominal aortic aneurysm, longer hospital length of stay was inversely correlated with mortality and thus improved outcomes [ 35 ].…”

“…The database was created by AHRQ (the Agency for Healthcare Research and Quality), which has been frequently used nationally as a public data source for analysis of variegated types and qualities of patient care and their associated results. This has allowed us to perform a comprehensive and holistic path to research diseases, a path to the ideal way to treat and care for patients with those diseases, and ultimately a path to find how patients respond to both the diseases and treatments [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. The NIS database includes certain weighting when constructing its sample of discharges and it excludes long-term acute care facilities and rehabilitation centers.…”