Mortality after emergency surgery continues to rise after discharge in the elderly

Rangel, Erika L.; Cooper, Zara; Olufajo, Olubode A.; Reznor, Gally; Lipsitz, Stuart R.; Salim, Ali; Kwakye, Gifty; Calahan, Christopher; Sarhan, Mohammad Abdelfattah; Hanna, Joseph

doi:10.1097/ta.0000000000000773

Cited by 39 publications

(37 citation statements)

References 37 publications

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“…Their surgical mortality and morbidity rates are higher than in younger patients. These statistics worsen when the emergency surgery factor is considered (10)(11)(12)(13). This is not only due to the combination of specific variables that characterise the disease itself but also to patient associated illnesses, cognitive and physical status, and social and family situation.…”

Section: Introductionmentioning

confidence: 97%

Multimodal Rehabilitation in Geriatric Emergency Surgery

Pereira¹,

Paduraru²

2017

chr

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Section: Introductionmentioning

confidence: 97%

Multimodal Rehabilitation in Geriatric Emergency Surgery

Pereira¹,

Paduraru²

2017

chr

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“…Hasil penelitian ini didapat angka mortalitas geriatri sebanyak 16 Penyebab mortalitas terbanyak pada geriatri yang menjalani operasi akut abdomen tahun 2014−2015 di RSUP Dr. Hasan Sadikin adalah syok septik (50%). Penelitian di Sumatera Utara tahun 2009 menyatakan penyebab mortalitas pasien geriatri adalah sepsis terkait dengan panperitonitis (5,3%) dan pneumonia (4,3%).…”

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“…Indeks massa tubuh sebagai variabel kontinu tidak selalu terkait dengan mortalitas dan morbiditas setelah dibanding dengan faktor lain seperti usia, jenis kelamin, pendidikan, kelompok etnis, kanker, merokok, dan demensia. 16 Hasil penelitian ini dari seluruh pasien geriatri yang mengalami mortalitas pascaoperasi emergensi akut abdomen didapat faktor predisposisi terbanyak adalah status gizi kurus dengan IMT <18,5 kg/m 2 pada 9 dari 16 subjek. Selain indeks massa tubuh rendah, hipoalbumin juga menjadi faktor predisposisi malnutrisi yang akan meningkatkan angka mortalitas dengan angka kejadian sebanyak 9 dari 16 subjek.…”

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“…Penelitian di Amerika Serikat tahun 2014 menyatakan IMT di bawah 18,5 kg/m 2 , kadar albumin serum rendah, status fisik ASA 4 dan Charlson score ≥4 diprediksi signifikan terjadi mortalitas. 16 Penelitian di Kanada tahun 2014 menyatakan IMT rata-rata pasien geriatri yang mengalami mortalitas pascaoperasi emergensi akut abdomen adalah 24,8 kg/m 2 dengan kadar albumin rata-rata 2,8 g/dL. 17 Diagnosis primer akut abdomen pada geriatri dinilai menantang, sering tidak memperlihatkan gejala khas dalam menggambarkan keadaan intra-abdomen yang sebenarnya.…”

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“…Hal ini sesuai dengan penelitian di Inggris tahun 2012 dan di Amerika Serikat tahun 2014 bahwa ada pasien geriatri yang menjalani operasi emergensi terutama kasus akut abdomen memiliki satus fisik ASA yang tinggi (ASA ≥4) karena keadaan komplikasi penyakit primer maupun keadaan medis penyakit penyerta akan meningkatkan angka morbiditas maupun mortalitas. 16,20 Penundaan dalam melaksanakan operasi emergensi pada geriatri sering terjadi karena terdapat komplikasi yang lebih lanjut baik dari penyakit penyerta yang dimiliki maupun penyakit primer. Pemeriksaan penunjang seperti laboratorium, rontgen toraks, CTscan di awal dapat mempercepat diagnosis akut abdomen sehingga memberikan hasil yang baik pada operasi yang akan dilakukan.…”

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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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Mortality and Health Care Utilization Among Medicare Patients Undergoing Emergency General Surgery vs Those With Acute Medical Conditions

et al. 2020

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IMPORTANCE Emergency general surgery (EGS) represents 11% of hospitalizations, and almost half of these hospitalized patients are older adults. Older adults have high rates of mortality and readmissions after EGS, yet little is known as to how these outcomes compare with acute medical conditions that have been targets for quality improvement. OBJECTIVE To examine whether Medicare beneficiaries who undergo EGS experience similar 1-year outcomes compared with patients admitted with acute medical conditions. DESIGN, SETTING, AND PARTICIPANTS This population-based, retrospective cohort study using Medicare claims data from January 1, 2008, to December 31, 2014, included adults 65 years or older with at least 1 year of Medicare claims who had urgent or emergency admissions for 1 of the 5 highest-burden EGS procedures (partial colectomy, small-bowel resection, peptic ulcer disease surgery, lysis of adhesions, or laparotomy) or a primary diagnosis of an acute medical condition (pneumonia, heart failure, or acute myocardial infarction). Patients undergoing EGS and those with acute medical conditions were matched 1:1 in a 2-step algorithm: (1) exact match by hospital or (2) propensity score match with age, sex, race/ethnicity, Charlson Comorbidity Index, individual comorbid conditions, claims-based frailty index, year of admission, and any intensive care unit stay. Data analysis was performed from July 16, 2018, to November 13, 2019. EXPOSURES Partial colectomy, small-bowel resection, peptic ulcer disease surgery, lysis of adhesions, or laparotomy or a primary diagnosis pneumonia, heart failure, or acute myocardial infarction. MAIN OUTCOMES AND MEASURES One-year mortality, postdischarge health care utilization (emergency department visit, additional hospitalization, intensive care unit stay, or total hospital encounters), and days at home during 1 year. RESULTS A total of 481 417 matched pairs (mean [SD] age, 78.9 [7.8] years; 272 482 [56.6%] female) with adequate covariate balance were included in the study. Patients undergoing EGS experienced higher 30-day mortality (60 683 [12.6%] vs 56 713 [11.8%], P < .001) yet lower 1-year mortality (142 846 [29.7%] vs 158 385 [32.9%], P < .001) compared with medical patients. Among 409 363 pairs who survived discharge, medical patients experienced higher rates of total hospital encounters in the year after discharge (4 vs 3 per person-year; incidence rate ratio, 1.31; 95% CI, 1.30-1.32) but had similar mean days at home compared with patients undergoing EGS (293 vs 309 days; incident rate ratio, 1.004; 95% CI, 1.004-1.004). CONCLUSIONS AND RELEVANCE In this study, older patients undergoing EGS had similarly high 1-year rates of mortality, hospital use, and days away from home as acutely ill medical patients. These findings suggest that EGS should also be targeted for national quality improvement programs.

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Mortality after emergency surgery continues to rise after discharge in the elderly

Abstract: Epidemiologic/prognostic study, level III; therapeutic study, level IV.

Cited by 39 publications

References 37 publications

Multimodal Rehabilitation in Geriatric Emergency Surgery

Multimodal Rehabilitation in Geriatric Emergency Surgery

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

Mortality and Health Care Utilization Among Medicare Patients Undergoing Emergency General Surgery vs Those With Acute Medical Conditions

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