Observational study of nonogenarians undergoing emergency, non-trauma surgery

Abstract

The study gave scientific support and actual figures to many intuitive beliefs: morbidity and mortality are high and are associated with many preoperative comorbidities. All this, combined with an already reduced life expectancy, and a presumably low physiological reserve makes these patients particularly vulnerable to emergency surgery.

Emergency surgery and American Society of Anesthesiologists physical status score are the most influential risk factors of death in nonagenarian surgical patients

“…There are relatively few studies regarding the results of gastrointestinal surgery in nonagenarians . The mortality obtained in our series, 28.9%, is within the range published in the literature, which includes figures as high as 55.0% . In a review carried out by Rivoirard et al ., operative mortality oscillated between 9.4% and 24.0% .…”

“…It is applicable from the preoperative period, and has also been validated as a predictor of morbidity, mortality and length of hospital stay, besides assisting decision‐making in the operating room . Several studies, as in our case, have observed a strong association between ASA‐PS and perioperative mortality in nonagenarians . In the present series, as the ASA‐PS score increased, the percentage of deaths also grew, escalating from a mortality of 11.5% in ASA II patients to a mortality of 37.5% in ASA IV patients.…”

“…These disparities clearly depend on whether the different cohorts include patients operated on as a matter of emergency. In our case, the mortality after elective surgery was just 4.8%, whereas mortality after emergent surgery was 37.6%; while in the Pelavski series, with 55.0% mortality, all patients were operated on in an emergency situation …”

Five‐year survival after surgery in nonagenarian patients

“…In the literature consulted, the mortality of elective surgery in this age group ranged from 4% to 20% . For emergency surgery, this ranged from 19% to 54.9% . In our case the figure was 37.6%, which we relate to the lack of patient selection.…”

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

“…In Italy, according to the Italian National Institute for Statistics (Istituto Nazionale di Statistica, ISTAT), there were approximately 13.5 million people aged 65 and older in 2016, representing 22.3% of inhabitants [3,4], and this value will continue to grow in the following years. Recovery, particularly for surgical emergencies, is considered complicated in the elderly [5][6][7], who tend to have longer hospital stays [7][8][9] (this is related to comorbidities, an elevated number of drugs taken, and reduced physical and mental reserves) [3,5,8,9]. Not all patients of the same age have the same risks or frailty issues (in Surgeries 2021, 2 120 multiple physiological systems, this is defined as age-related cumulative decline, and is considered a better predictor of mortality and morbidity than chronological age in the elderly).…”