Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients

Abstract

Background: the general population is aging across the world. Therefore, even surgical interventions in the elderly—in particular those involving emergency surgical admissions—are becoming more frequent. The elderly population is often frail (in multiple physiological systems, this is often defined as age-related cumulative decline). This study involved a 2-year follow-up evaluation of frail elderly patients treated with urgent surgical intervention at Santa Maria Regina della Misericordia Hospital, General Surgery Department, in Adria (Italy). Method: a prospective, single-center, 2-year follow-up study of 120 patients >65 years old, treated at our department for surgical abdominal emergencies. We considered co-morbidities (ASA—American Society of Anesthesiologists Physical Status Classification System—score), type of surgery (laparoscopy, laparotomy or converted), frailty score, mortality, and complications at 30 days and at 2 years. Conclusions: 70 (58.4%) patients had laparoscopy, 49 (40.8) had laparotomy, and in 1 (0.8%) case, surgery was converted from laparoscopy to laparotomy. Mortality strictly depends on the type of surgery (laparotomy vs. laparoscopy), complications during recovery, and a lower Fried frailty criteria score, on average. The long-term follow-up can be a useful tool to highlight a safer surgical approach, such as laparoscopy, in frail elderly patients. We consider the laparoscopic approach feasible in emergency situations, with similar or better outcomes than laparotomy, especially in frail elderly patients.

Complicated Abdominal Wall Hernias in the Elderly: Time Is Life and Comorbidities Matter

“…Notably, laparoscopic repair was shown to be protective against surgical site infection which agrees with previous reports. [18][19][20] This may possibly be due to smaller incisions used for port insertion. The use of laparoscopy in the management of an acutely complicated hernia remains a matter of controversy, [18][19][20] particularly in the setting of comorbidities that may affect maintenance of the required pneumoperitoneum and increased operative time, as well as anticipated need of bowel resection.…”

“…[18][19][20] This may possibly be due to smaller incisions used for port insertion. The use of laparoscopy in the management of an acutely complicated hernia remains a matter of controversy, [18][19][20] particularly in the setting of comorbidities that may affect maintenance of the required pneumoperitoneum and increased operative time, as well as anticipated need of bowel resection. Our results do not show association between laparoscopic repair and mortality after adjusted multivariable analysis considering comorbidities and operative factors, which together with the reduction in SSI risk supports consideration of this approach during management decision-making, whenever patient factors allow.…”