Emergency abdominal surgery in the aged

Abstract

SUMMARYThe results of 375 emergency abdominal operations in elderly patients over the age of 75 years are presented and discussed in detail. There has been a fourfold increase in the population over the age of 75 years in England and Wales during the 60-year period from 1911 to 1971. The overall mortality of these patients of 31.7per cent is unrelated to the age of the patient, but appears to be directly related to the severity of the surgical condition and to cardiorespiratory complications. Our approach to these problems is presented and discussed.THE widespread application of preventive medicine and improved medical resources in the twentieth century has resulted in an increase in the number of elderly people in our community. In certain areas this is accentuated by an influx of retired people. Bournemouth is such a 'retirement' area as demonstrated by the 1971 census which showed a total population of 183332 with 19339 people over the age of 75 years (Office of Population Censuses and Surveys, 1973). This represents 10.5 per cent of the local population. In comparison with the national figures this is twice the average (Office of Population Censuses and Surveys, 1975). Because of the large numbers of elderly people in our local community we decided to study the results of emergency abdominal surgery in patients over the age of 75 years. PatientsWe have defined a case as an emergency if it was deemed deleterious to the patient to delay surgery until the next routine operating list. The age limit of 75 years was taken arbitrarily, as we considered anyone over the age of 75 years represented a geriatric patient. The cases were collected from the theatre operation registers and included both public and private patients who were admitted to the Royal Victoria Hospital, Bournemouth. During the 6)-year period from January 1969 to March 1975,392emergency abdominal operations were performed on patients over the age of 75 years. Of these, the case records were obtained for 375 operations, representing a retrieval rate of 95.7 per cent. Using a prepared pro forma, a retrospective examination of the notes was undertaken with regard to the patients' age, sex, general clinical condition, details of operation, complications and mortality. A period of 30 days following operation was taken as an arbitrary figure in which morbidity and mortality resulting from surgery were considered likely to occur.

Post-Operative Complications in the Elderly Surgical Patient

“…While the levels of post-operative morbidity we encountered, particularly in the respiratory and cardiac systems, were generally higher than those found in earlier retrospective reports [Klug and McPherson, 1959;Wilder and Fishbein, 1961;Andersen et al, 1965;Claes et al, 1966;Griffiths, 1972;Rzepiela, 1973;Blake and Lynn, 1976;Mlynek et al, 1977] this probably reflects the greater sensitivity of the prospective method of evaluation [Latimer e t al, 1971;Mason et al, 1977] used in the present study.…”

“…The majority of studies of post-operative morbidity in elderly patients have been retro spective [Klug and McPherson, 1959;Wilder and Fishbein, 1961;Andersen et al, 1965;Claes et al, 1966;Griffiths, 1972;Rzepiela, 1973;Blake and Lynn, 1976;Mlynek et al, 1977] and, as a result of this, may have underestimated the extent of the problem [Latimer et al, 1971;Mason et al, 1977], A prospective study of post-operative compli cations in elderly general surgical patients is therefore reported, together with an evalua 1 Based on initial material presented to the Spring Meeting of the British Geriatrics Society, Isle of Man 1980. tion of the way that sex, age, urgency of sur gery, type of surgery, and patient fitness af fect post-operative morbidity.…”

Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

“…[4][5][6][7][8][9] Previous research has consistently demonstrated that emergency abdominal surgery in elderly patients is associated with increased morbidity and mortality compared with elective surgery or emergency surgery in younger patients. [10][11][12][13][14][15][16][17][18][19][20] Accordingly, the decision to proceed with surgery must be considered carefully. In contrast, delaying necessary surgery in elderly patients has also been associated with very poor outcomes.…”

A Review of Risk Factor in the Elderly Candidate for Surgery and Anesthesia

“…Another study 9 indicates that patients 65 to 74 years of age have an overall mortality of 9.9%, whereas patients 75 years of age and over have a 20.9% mortality. Both of these studies, and those of Blake and Lynn, 16 indicate that real senescence begins around 75 years of age, with respect to operative mortality.…”

“…Some studies show the real "age of senescence" as far as operative mortality is concerned is around 75 years of age. 7,9,16 The presence of major mental illness such as dementia or overt psychosis in old people carries a 45% operative mortality. 7 It would be interesting to know if this finding is related to the high mortality seen in malnourished patients, described by Harken, 22 as severely psychotic patients frequently are in a wasted state.…”