Emergency Abdominal Operations in the Elderly: A Multivariate Regression Analysis of 430 Consecutive Patients with Acute Abdomen

Ukkonen, Mika; Kivivuori, Antti; Rantanen, Tuomo; Paajanen, Hannu

doi:10.1007/s00268-015-3207-1

Cited by 34 publications

(27 citation statements)

References 23 publications

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“…Multivariable analysis in the present study did not identify any association between intention of surgery (palliative versus curative) or urgency of surgery and morbidity or mortality. Previous studies with fewer patients suggested that palliative and emergency resections had substantially higher rates of postoperative morbidity and mortality. Here, urgency and intention of surgery had a significant impact only in univariable analysis.…”

Section: Discussionmentioning

confidence: 97%

Morbidity and mortality according to age following gastrectomy for gastric cancer

Nelen

Bosscha

Lemmens

et al. 2018

British Journal of Surgery

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Section: Discussionmentioning

confidence: 97%

Morbidity and mortality according to age following gastrectomy for gastric cancer

Nelen

Bosscha

Lemmens

et al. 2018

British Journal of Surgery

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“…For example, in acute appendicitis the reported mortality rate in patients aged over 70 years is six to seven times higher than in those aged 20–49 years. Perioperative mortality after emergency abdominal surgery is usually reported to be about 15–20 per cent, depending on age and diagnosis. Mortality increases with every decade of age beyond 50 years, reaching 40–50 per cent in those aged 80 years and above.…”

Section: Mortality After Emergency General Surgery In the Elderlymentioning

confidence: 99%

Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2016

Journal of British Surgery

147

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Background: Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care.Methods: This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. Results:The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care.Conclusion: Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.

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“…Gallbladder disease is among the leading causes for hospital admission for acute abdomen among adults and the most common indication for abdominal surgery in the elderly [7, 8]. In situations when LC is unsafe the surgeon might have to convert to an open procedure.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

2016

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BackgroundThe purpose of the study was to identify risk factors for conversion of laparoscopic cholecystectomy and risk factors for postoperative complications in acute calculous cholecystitis. The most common complications arising from cholecystectomy were also to be identified.MethodsA total of 499 consecutive patients, who had undergone emergent cholecystectomy with diagnosis of cholecystitis in Meilahti Hospital in 2013–2014, were identified from the hospital database. Of the identified patients, 400 had acute calculous cholecystitis of which 27 patients with surgery initiated as open cholecystectomy were excluded, resulting in 373 patients for the final analysis. The Clavien-Dindo classification of surgical complications was used.ResultsLaparoscopic cholecystectomy was initiated in 373 patients of which 84 (22.5%) were converted to open surgery. Multivariate logistic regression identified C-reactive protein (CRP) over 150 mg/l, age over 65 years, diabetes, gangrene of the gallbladder and an abscess as risk factors for conversion. Complications were experienced by 67 (18.0%) patients. Multivariate logistic regression identified age over 65 years, male gender, impaired renal function and conversion as risk factors for complications.ConclusionsAdvanced cholecystitis with high CRP, gangrene or an abscess increase the risk of conversion. The risk of postoperative complications is higher after conversion. Early identification and treatment of acute calculous cholecystitis might reduce the number of patients with advanced cholecystitis and thus improve outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-016-0111-4) contains supplementary material, which is available to authorized users.

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Emergency Abdominal Operations in the Elderly: A Multivariate Regression Analysis of 430 Consecutive Patients with Acute Abdomen

Abstract: Despite modern diagnostics and improved surgical techniques, the results of emergency abdominal surgery still have relatively high morbidity and mortality as reported in earlier studies.

Cited by 34 publications

References 23 publications

Morbidity and mortality according to age following gastrectomy for gastric cancer

Morbidity and mortality according to age following gastrectomy for gastric cancer

Emergency general surgery in the geriatric patient

Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

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