Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population

Elamin, Abubaker; Tsoutsanis, Panagiotis; Sinan, Laith; Tari, Seyedh Paniz Hashemi; Elamin, Wafa; Kurihara, Hayato

doi:10.1055/s-0042-1756461

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…Laboratory assessment focused on renal function tests, arterial blood gas (ABG) analysis, serum electrolytes, and urinalysis. Moreover, the following scores were assessed for all patients on ICU admission: the "Glasgow Coma Scale" (GCS) [6] , "Acute Physiology and Chronic Health Evaluation II" (APACHE II) score [7] , and "Simplified Acute Physiology Score III" (SAPS III) [8] .…”

Section: Methodsmentioning

confidence: 99%

Comparison between Watchful Waiting Strategy and Early Initiation of Renal Replacement Therapy in The Critically Ill Acute Kidney Injury

2024

The Egyptian Journal of Hospital Medicine

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Background: The timing of "renal replacement therapy" (RRT) in patients with "acute kidney injury" (AKI) has been greatly debated among nephrologists. Some prefer the initial regimen; rapidly correct metabolic disturbances and fluid overload, while others prefer the delayed approach to avoid possible RRT complications. Objective: To compare the outcomes of early versus delayed RRT in intensive care unit (ICU) patients diagnosed with stage 3 AKI. Patients and methods: In this prospective study, 104 ICU patients with stage 3 AKI diagnoses were enrolled and then randomly assigned to two groups; Group A included patients who received RRT within 24 hours of AKI diagnosis, and Group B included other patients who had RRT after 24 hours. Results: Sepsis/septic shock was the most common etiology of AKI in both groups. Other causes included major surgery, hypovolemic/hemorrhagic shock, and cardiogenic shock. The two groups showed comparable needs for vasopressor support and mechanical ventilation. Nonetheless, the duration of RRT, mechanical ventilation, ICU stay, and hospitalization decreased significantly in the early group. In-hospital mortality increased significantly with the delayed approach (65.38% vs. 42.3% in the early group) (p = 0.034). Discharge creatinine in the survived cases was lower in the early group (2.01 vs. 2.77 in delayed casesp < 0.001). Conclusion:Early RRT is associated with better outcomes compared to the delayed one in patients with stage 3 AKI. Therefore, early RRT is recommended in such cases to improve patient outcomes.

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Section: Methodsmentioning

confidence: 99%

Comparison between Watchful Waiting Strategy and Early Initiation of Renal Replacement Therapy in The Critically Ill Acute Kidney Injury

2024

The Egyptian Journal of Hospital Medicine

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“…As the demographic shift unfolds, the proportion of older adults, aged 65 years and older, requiring emergency general surgery procedures (EGSPs) continues to increase, 4 and currently accounts for 30% of the emergency general surgery (EGS) patient population. 5 Older adults undergoing EGSPs experience significantly higher mortality, ranging between 15 and 34%, when compared to their younger counterparts. 6,7 Additionally, many require discharge to a higher level of care postoperatively.…”

Section: Introductionmentioning

confidence: 97%

Emergency General Surgery Procedures in Older Adults: Where You Live Matters!

Dhillon

Kufera

Ghneim

2023

The American Surgeon™

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Background Neighborhood location and its built environment are important social determinants of health that impact health outcomes. Older adults (OAs) represent the fastest growing population in the United States with many requiring emergency general surgery procedures (EGSPs). The aim of this study was to evaluate whether neighborhood location, represented by zip code, influences mortality and disposition in OAs undergoing EGSPs in Maryland. Methods A retrospective review was undertaken of hospital encounters in the Maryland Health Services Cost Review Commission from 2014 to 2018 of OAs undergoing EGSPs. Older adults residing in the 50 most affluent (MANs) and 50 least affluent (LANs) neighborhoods based on zip codes were compared. Data collected included demographics, all patient-refined (APR)-severity of illness (SOI), APR-risk of mortality (ROM), Charlson Comorbidity Index, complications, mortality, and discharge to a higher level of care. Results Of the 8661 OAs analyzed, 2362 (27.3%) resided in MANs and 6299 (72.7%) in LANs. Older adults in LANs were more likely to undergo EGSPs, had higher APR-SOI and APR-ROM, and experienced more complications, discharge to higher level of care, and mortality. Living in LANs was independently associated with discharge to higher level of care (OR 1.56, 95% CI: 1.38-1.77, P < .001) and increased mortality (OR 1.35, 95% CI: 1.07-1.71, P = .01). Discussion Mortality and quality of life in OAs undergoing EGSPs are dependent on environmental factors likely determined by neighborhood location. These factors need to be defined and incorporated in predictive models of outcomes. Public health opportunities to improve outcomes for those who are socially disadvantaged are necessary.

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Prediction of Mortality and Length of Hospital Stay in Geriatric Patients Undergoing Emergency General Surgery: Use of the SHARP Score

Okay,

Özensoy

2024

The American Surgeon™

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Background The need for emergency general surgery (EGS) in geriatric patients is increasing with the aging population. The aim of this study was to evaluate the ability of SHARP score to predict mortality rate and length of hospital and emergency service stay for EGS patients. Methods Patients aged ≥65 years who applied to the emergency service, required EGS, and underwent surgery between February 1, 2022, and January 31, 2023, were retrospectively analyzed from our hospital’s information system. Demographic data (age, gender, and comorbidities), surgical diagnoses, and SHARP risk scores of the patients were evaluated. Also, 30-day mortality and length of stay in the emergency service and hospital were examined. Results A total of 386 patients were evaluated in this study. The mean age of these patients was 75 years (65-94). The most common cause of EGS was hernia. The cause with the highest mortality was intraabdominal perforations. The presence of malignancy and an increase in the number of comorbidities were associated with mortality. SHARP scores of 3, 4, and 5 were significantly associated with length of hospital stay and mortality. Conclusion We recommend considering the SHARP risk score to predict mortality and length of hospital stay in geriatric EGS patients.

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Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population

Cited by 3 publications

References 26 publications

Comparison between Watchful Waiting Strategy and Early Initiation of Renal Replacement Therapy in The Critically Ill Acute Kidney Injury

Comparison between Watchful Waiting Strategy and Early Initiation of Renal Replacement Therapy in The Critically Ill Acute Kidney Injury

Emergency General Surgery Procedures in Older Adults: Where You Live Matters!

Prediction of Mortality and Length of Hospital Stay in Geriatric Patients Undergoing Emergency General Surgery: Use of the SHARP Score

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