Meta-analysis of mortality risk in octogenarians undergoing emergency general surgery operations

Abstract

Background: This study aimed to quantify the risk of perioperative mortality in octogenarians undergoing emergency general surgical operations and to compare such risk between octogenarians and nonoctogenarians. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards to identify studies reporting the mortality risk in patients aged over 80 years undergoing emergency general surgery operations. The primary outcome measure was 30-day mortality, which was stratified based on American Society of Anesthesiologists (ASA) status and procedure type. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Random-effects models were applied to calculate pooled outcome data. Results: Analysis of 66,701 octogenarians from 22 studies showed that the risk of 30-day mortality was 26% (95% confidence interval 18%e34%) for all operations: 29% (95% confidence interval 25%e33%) for emergency laparotomy; 9% (95% confidence interval 1%e23%) for nonlaparotomy emergency operations; 21% (95% confidence interval 13%e30%) for colon resection; 17% (95% confidence interval 11%e25%) for small bowel resection; 9% (95% confidence interval 7%e11%) for adhesiolysis; 6% (95% confidence interval 5.9%e6.8%) for perforated ulcer repair; 3% (95% confidence interval 2.6%e4%) for appendicectomy; 3% (95% confidence interval 2.8%e3.3%) for cholecystectomy; and 5% (95% confidence interval 0.2%e14%) for hernia repair. When stratified based on the patient's ASA status, the risk was 11% (95% confidence interval 4%e20%) for ASA 2 status, 22% (95% confidence interval 10%e36%) for ASA 3 status, 39% (95% confidence interval 29%e48%) for ASA 4 status, and 94% (95% confidence interval 77%e100%) for ASA 5 status. The risk was higher in octogenarians compared with nonoctogenarians (odds ratio: 4.07, 95% confidence interval 2.40e6.89), patients aged 70 to 79 (odds ratio: 1.21, 95% confidence interval 1.13e1.31), and patients aged 50 to 79 (odds ratio: 2.03, 95% confidence interval 1.68e2.45). Conclusion:The risk of perioperative mortality in octogenarians undergoing emergency general surgical operations is high. The risk of perioperative death in this group is higher than in younger patients. Laparotomy, bowel resection, and ASA status above 3 carry the highest risk.

Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study

“…The probability of suffering recurrent gallbladder-related complications extends up to five years after the index case of pancreatitis. In addition, the reported mortality of emergency surgery for cholecystectomy in some reports is still lower than the mortality rate when not undergoing surgery (18,19). Even though complications following cholecystectomy for cholecystitis is twice that in patients with a CCI of 5 or higher, the morbidity rate is still under 15 %, and less than 5 % were major complications (20).…”

Development and Validation of HAS (Hajibandeh Index, ASA Status, Sarcopenia) - A Novel Model for Predicting Mortality After Emergency Laparotomy

“…Finally, the strong predictive significance of ASA status in patients undergoing EL is very well established. 12,13 Once externally validated by others, there are several aspects that may make the HAS an acceptable and practical tool to be used for predicting the risk of postoperative mortality in patients who need EL. It is simple and easy to use.…”

“…We learned from previous studies that the modern predictors of mortality in patients undergoing EL include age over 80, 12,13 sarcopenia, 14 frailty, 15,16 American Society of Anesthesiologists (ASA) status, 12,13 need for bowel resection, 12 and presence of intraperitoneal contamination 13 . In addition to the above predictors, the Hajibandeh Index (HI), derived from combined levels of C-reactive protein (CRP), lactate, neutrophils, lymphocytes, and albumin, is a strong predictor of mortality in patients undergoing EL 9,17 .…”

Predictive Performance of NELA Versus P-POSSUM Mortality Scores: Are We Underestimating the Risk of Mortality Following Emergency Laparotomy?

“…The authors argued that the comparable performance of the HI and NELA model suggests that the NELA model may not efficiently take into account the parameters that it asks for [ 9 ]. These findings may suggest that the current predictive tools do not take into account the modern predictors of mortality efficiently and may indicate that future studies should focus on the development and validation of scoring systems that take into account all of the modern predictors of mortality in patients undergoing emergency laparotomy such as HI [ 9 ], age over 80 [ 3 , 4 ], sarcopenia [ 5 ], ASA status above 3 [ 3 , 4 ], need for bowel resection [ 4 ], and presence of intraperitoneal contamination [ 3 ].…”

“…Emergency laparotomy is associated with a high risk of mortality, almost 10 times greater than that of major elective gastrointestinal surgery [1,2]. In addition to the operation-related factors, many patient-related factors also contribute to the outcomes of emergency laparotomy such as age, comorbidities, performance status, frailty, sarcopenia, and presence of peritoneal contamination [3][4][5]. Such factors need to be carefully addressed preoperatively to assess the likelihood of survival after emergency laparotomy.…”