Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids

Abstract

Background The study explored determinants of mortality of admitted emergently patients with the primary diagnosis of hemorrhoids, during the years 2005-2014. Methods Demographics, clinical data, and outcomes were obtained from the National Inpatient Sample, 2005-2014, in elderly (65+ years) and non-elderly adult patients (18-64 years) with hemorrhoids who underwent emergency admission. Multivariable logistic regression model with backward elimination was used to identify predictors of mortality. Results 25 808 adult and 26 978 elderly patients were included. Female patients consisted of 42.5% and 59.3% in adult and elderly, respectively. 42 (.2%) adults died, of which 50% were female and 125 (.5%) elderly patients died, of which 60% were female. Mean (SD) age of the adult patients was 47.8 (11) years and in elderly patients was 78.7 (8) years. 82.2% and 85.7% had internal hemorrhoids in adult and elderly patients, respectively. 9326 (36.1%) adult and 7282 (27%) elderly patients underwent an operation. In the final multivariable logistic regression model for adult patients with operation, delayed operation and invasive diagnostic procedures increased the odds of mortality, whereas in elderly patients, delayed operation and frailty index were the risk factors of mortality. In both adults and elderly with no operation, increased hospital length of stay (HLOS) significantly increased the odds of mortality, and undergoing an invasive diagnostic procedure significantly decreased the odds of mortality. Conclusion In all operated patients, increased time to operation and undergoing an invasive diagnostic procedure were the risk factors for mortality. On the other hand, in non-operated emergency hemorrhoids patients, increased age and increased HLOS were the risk factors for mortality while undergoing an invasive diagnostic procedure decreased the odds of mortality.

Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients

“…This helps explain our findings that adult non-operative patients may be considered higher risk, based on the presence of more comorbidities, and their vulnerability to additional days in the hospital. Interestingly, our study did not find time to operation to be a risk factor for mortality, contrary to other studies where an increased time to operation increased the odd of mortality [ 13 , 25 , 34 , 35 , 38 , 40 ]. While there is ample literature studying the different surgical methods for umbilical hernia repair, there is clearly a need to further investigate the impact of delaying surgery, HLOS, and the non-operative “watchful waiting” approach on the mortality of patients with UH.…”

“…Specifically, there was a 7.7% increase in the odds of mortality for each additional day spent in the hospital. Similarly, associations between mortality and HLOS were noted in multiple recent retrospective studies on patients emergently admitted with gastroparesis, hemorrhoids, duodenal ulcers, blunt chest wall trauma, tracheostomy, rectal malignancy, total hip arthroplasty, and paralytic ileus [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. The HLOS was not a significant predictor for mortality in the elderly sample, despite elderly patients experiencing a longer HLOS ( Table 2 ).…”

Adult and Elderly Risk Factors of Mortality in 23,614 Emergently Admitted Patients with Rectal or Rectosigmoid Junction Malignancy

“…Grass et al assessed the impact of delay from diagnosis to curative surgery on survival in patients with non-metastatic colon cancer and observed that the adjusted hazard ratio for mortality increased with delay times of longer than 30 days, to become significant after a delay of 40 days [ 26 ]. In prior NIS database studies, emergently admitted patients with ventral hernia, chronic duodenal ulcers, or hemorrhoids with previous surgery exhibited longer time to operation among the main risk factors for mortality [ 27 , 28 , 29 , 30 ].…”

Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors

“…Lin et al revealed significant associations between mortality and increased HLOS in elderly and non-elderly patients hospitalized with chronic duodenal ulcers [ 26 ]. An investigation of 52,786 patients demonstrated increased HLOS was a risk factor for mortality in non-operated emergency hemorrhoid patients [ 27 ]. Lastly, a large-scale retrospective analysis of 48,539 patients who were managed non-operatively following emergent admission for ventral hernia displayed significant associations between mortality and increased HLOS [ 28 ].…”