Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: A single center experience

Ong, Marc Weijie

doi:10.4240/wjgs.v7.i9.208

Cited by 52 publications

(51 citation statements)

References 16 publications

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“…[14] We did not find a statistically significant difference in patients operated on within 24 hours in terms of early mortality rate. We have to consider that several patients needed to be monitored and clinically stabilized in department of internal medicine before surgery, and this may be a factor responsible for delay in surgery.…”

Section: Discussionmentioning

confidence: 55%

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Simone

Ansaloni²,

Tarasconi³

et al. 2016

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Colorectal cancer (CRC) is predominantly a disease of elderly people. Cancer in nonagenarian patients presents an ethical dilemma for surgeons and oncologists, and management of this group of patients in emergency for complicated CRC is debated. Presently described is retrospective study reporting experience of 6 departments of emergency surgery with management of nonagenarian patients sent to emergency surgery for CRC complications. METHODS: Data concerning patients aged over 90 years hospitalized from January 2011 to June 2015 in 6 departments of emergency surgery for complicated CRC were retrospectively analyzed. Data were collected in a dedicated database. Statistical analysis was conducted using IBM software SPSS 22 (IBM Corp., Armonk, NY, USA); statistical significance was set at p=0.05. RESULTS: In the period of study,19 patients aged over 90 underwent surgery in emergency department for complicated CRC. Of the total, 52.63% were female, with sex ratio F:M of 1.11:1. Mean age was 92.52 years (range: 90-97 years; SD 1.49). Preoperative assessment of surgical risk was made using American Society of Anesthesiologists (ASA) score. There was no statistically significant difference in terms of in-hospital mortality between patients with ASA score ≤ 3 and patients with an ASA score >3. Primary anastomosis was performed in 6 of 19 patients (31.57%), all of whom had right-side colon cancer. Diverting stoma was created for 12 of 19 patients (63.15%). There was a statistically significant difference in incidence of postoperative complications between patients with right-side colon cancer and patients with left-side colon cancer (p=0.0498). Mean length of hospital stay was 12.78 days (range: 2-31 days; SD 6.31). In-hospital mortality rate was 21.05% (n=4). At follow up, overall survival was 47.36% (n=9). CONCLUSION: Elective surgery is the best way to manage CRC in all patients affected. Emergency surgery for CRC complications in patients over 90 is feasible with careful preoperative selection and evaluation of the patient. One-stage surgery is the best choice, in selected patients. Two-and three-stage surgery is indicated in case of peritonitis, for frail patients, for hemodynamically unstable patients. If there is high risk of anastomotic leakage, decompressive stoma is suggested as bridge to elective surgery, and in advanced neoplastic disease, as palliative procedure. In emergency setting, diverting stoma is a good surgical option in nonagenarian patients to decrease surgical risk, morbidity, and mortality; however, clinical randomized controlled trials are necessary to confirm this.

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Section: Discussionmentioning

confidence: 55%

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Simone

Ansaloni²,

Tarasconi³

et al. 2016

Ulus Travma Acil Cerrahi Derg

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“…resection-anastomosis between two necrosed part was done. 3 Till now no such case have been reported where perforation in mid of the scrotal content occur along with the perforation of intra-peritoneal part of intestine(jejunum). Obstructed or strangulated direct inguinal hernia perforation doesn't occur in intraperitoneal part of intestine.…”

Section: Figure 2: Resection Anastomosis Of Hernia Component(ileum) mentioning

confidence: 99%

“…3 Normally perforation occur at the site of constricting ring but here perforation occur in middle part of the hernial content. There was spillage of fecal content into scrotum through superficial ring hence abdomen was opened through mid-line incision.…”

Section: Figure 2: Resection Anastomosis Of Hernia Component(ileum) mentioning

confidence: 99%

Strangulated direct inguinal hernia with intraperitoneal perforation

Bakhteyar¹,

Kumar²,

Kumar³

2017

Int Surg J

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Usually direct inguinal hernia doesn’t present as strangulation or incarceration as compared to indirect inguinal hernia because of earlier has wider neck. A patient of recurrent direct inguinal hernia presents as intra-scrotal gangrene and intra-peritoneal perforation. We reported a case of 65 years old male presented with septicemia and right sided strangulated direct hernia. On exploration through inguino scrotal incision and mid line laparotomy, gangrenous loop was found in scrotum and perforation was found in intra-peritoneal part of small intestine. Resection-anastomosis was done for both the parts of intestine. Inguinal Incision was closed by posterior wall closure and modified Bassini’s herniorraphy. Abdomen was closed in layers with brain. Long standing direct hernia may present as strangulation or incarceration specially in elderly but perforation and gangrene of intra-peritoneal part of small intestine is very rare.

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“…Waktu toleransi untuk keterlambatan tersebut berbanding terbalik dengan kenaikan tingkat usia. 14 Alasan penundaan operasi geriatri pada penilaian praanestesi adalah populasi geriatri sering tidak menunjukkan gejala yang khas dan kurang spesifik terhadap suatu penyakit dibanding dengan dewasa muda sehingga dibutuhkan waktu yang lebih lama dalam pemeriksaan untuk menilai kondisi dan menegakkan diagnosis. Pasien geriatri sering memiliki beberapa kondisi medis penyakit penyerta yang memerlukan optimalisasi sebelum dilakukan operasi sehingga akan meningkatkan waktu tunda.…”

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“…Penyakit penyerta ini terbukti menjadi indikator kuat prognostik negatif terhadap hasil keluaran pascaoperasi bila dibanding dengan faktor usia. 14 Hasil penelitian ini menunjukkan pada kasus mortalitas didapat waktu respons penanganan >6 jam sebanyak 15 dari 16 subjek. Penelitian di Denmark tahun 2014 menyatakan penundaan operasi akut abdomen >6 jam pada geriatri meningkatkan angka mortalitas sebanyak 1,5 kali.…”

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Angka Mortalitas dan Faktor Risiko pada Pasien Geriatri yang Menjalani Operasi Emergensi Akut Abdomen di RSUP Dr. Hasan Sadikin Bandung Tahun 2014−2015

Priyatmoko¹,

Sudjud²,

Kadarsah³

2017

jap

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AbstrakGeriatri memiliki kekhususan yang perlu diperhatikan dalam bidang anestesi dan tindakan operasi karena terdapat kemunduran sistem fisiologis dan farmakologis sejalan dengan penambahan usia. Penelitian di Yunani tahun 2007 menjelaskan bahwa angka mortalitas akibat tindakan operasi setelah usia 65 tahun menjadi 3 kali lipat dibanding dengan usia 18−40 tahun. Angka mortalitas geriatri tahun 2007 pada operasi elektif sebesar 5%, sedangkan operasi emergensi sebesar 10%. Tujuan penelitian ini adalah memperoleh angka mortalitas dan faktor risiko pada pasien geriatri yang menjalani operasi emergensi akut abdomen tahun 2014−2015. Tipe penelitian ini merupakan deskriptif dengan pendekatan retrospektif terhadap 180 subjek penelitian yang diambil di bagian rekam medis sejak Juli−Oktober 2016 pada pasien geriatri yang menjalani operasi emergensi akut abdomen di RSUP Dr. Hasan Sadikin Bandung tahun 2014−2015.Hasil penelitian ini memperlihatkan angka mortalitas sebesar 9% dengan faktor penyebab mortalitas paling dominan adalah syok sepsis sebesar 50%. Faktor predisposisi disebabkan oleh indeks massa tubuh <18,5 kg/m 2 sebesar 56,3%, diagnosis primer tumor intestinal sebesar 31,3%, penyakit penyerta diabetes melitus sebesar 31,3%, sepsis sebesar 93,8%, hipoalbumin sebesar 56,3% dan status fisik ASA 4E sebesar 62,5%. Simpulan, faktor presipitasi disebabkan oleh waktu respons penanganan >6 jam sebesar 93,8% dan komplikasi pascaoperasi severe sepsis disertai pneumonia sebesar 50%.Kata kunci: Akut abdomen, angka mortalitas, geriatri, operasi emergensi Mortality Rate and Risk Factors in Geriatric Patients Undergo Emergency Acute Abdomen Surgery in Dr. Hasan Sadikin General Hospital Bandung in 2014−2015 AbstractSpecific anesthetic and surgical considerations apply for geriatric patients due to reduced physiologic functions and pharmacodynamics as the age increase. A study in Greece in 2007 shows that surgery in patients more than 65 year old has three times mortality rate than surgery in 18-40 years old patients. Geriatric mortality rate in elective surgery in 2007 is 5%, while the rate for emergency surgery is 10%. The purpose of this study was to identify the mortality rate and risk factors in geriatric patients underwent emergency acute abdomen surgery in 2014−2015. This was a descriptive retrospective study on 180 medical records of geriatric patients who underwent emergency acute abdomen surgery during the period of July to October 2016 in Dr. Hasan Sadikin General Hospital in 2014−2015. The results of this study showed a mortality rate of 9%, with septic shock as the most dominant factor that causes mortality (50%). The predisposing factors were body mass index <18.5 kg/m2 (56.3%), diagnosis of primary intestinal tumor (31.3%), diabetes mellitus comorbidities (31.3%), sepsis (93.8%), hypoalbuminemia (56.3%), and ASA physical status 4E (62.5%). In conclusion, the precipitation factors are caused by a response time of >6 hours (93.8%) and postoperative severe sepsis complications with pneumonia (50%).

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Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: A single center experience

Abstract: Delays in performing emergency surgery in elderly lead to higher complication rates. Obtaining CT scans early also may facilitate prompt diagnosis of certain abdominal emergencies where presentation is more equivocal and this may lead to improved surgical outcomes.

Cited by 52 publications

References 16 publications

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Strangulated direct inguinal hernia with intraperitoneal perforation

Angka Mortalitas dan Faktor Risiko pada Pasien Geriatri yang Menjalani Operasi Emergensi Akut Abdomen di RSUP Dr. Hasan Sadikin Bandung Tahun 2014−2015

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