Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies

Hentati, Hassen; Salloum, Chady; Caillet, Philippe; Lahat, Eylon; Disabato, Mara; Levesque, Éric; Compagnon, Philippe; Lim, Chetana; Azoulay, Daniel

doi:10.1007/s00268-017-4419-3

Cited by 11 publications

(11 citation statements)

References 42 publications

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“…A high index of suspicion with a low threshold to perform further investigations in a timely manner is recommended in order to ensure diagnosis. Mortality is associated with delayed diagnosis and thus early investigation is important [ 309 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although several risk‐stratification tools have been proposed [ 304 , 316 , 319 , 320 ], none has been validated in large volume clinical practice [ 301 ]. Outcome is based on pathology, physiological disturbance and underlying comorbidity [ 309 ]. However, the use of risk calculators available for emergency laparotomies has been shown to reduce variability in the perception of risk by surgeons [ 325 ].…”

Section: Introductionmentioning

confidence: 99%

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The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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“…Over the past century, the constant increase in life expectancy has been responsible for a corresponding rise in disease management and operative procedures in older adults [ 1 ]. Although general anesthesia (GA) is routinely used for major abdominal surgery, it is accompanied by significant morbidity and mortality, especially in elderly patients suffering from multiple severe systemic diseases (American Society of Anesthesiologists [ASA] classification III or above) [ 2 ]. Accordingly, regional anesthesia, particularly neuraxial blockade, has gained popularity as an effective and safe technique that might provide improved outcomes in terms of perioperative morbidity and mortality compared to GA, although conclusive, long-term evidences are still missing [ [3] , [4] , [5] ].…”

Section: Introductionmentioning

confidence: 99%

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

Vincenzi

Starnari

Faloia

et al. 2020

Surgery Open Science

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Background Limited studies have applied thoracic continuous spinal anesthesia in abdominal surgery, relying exclusively on opioids. This retrospective study analyzes 2 different schemes of thoracic continuous spinal anesthesia and postoperative analgesia in elderly patients undergoing major abdominal surgery. Methods A total of 98 patients aged ≥ 75 years were divided into 2 groups. The control group (60 patients) received bupivacaine plus fentanyl, whereas the study group (38 patients) received bupivacaine plus ketamine and midazolam. Both received analogous postoperative continuous intrathecal analgesia. Several perioperative variables were evaluated. Results Spinal anesthesia was performed without complications in all patients. Doses of noradrenaline administered, incidence of respiratory depression, need for intraoperative sedation, and time to first flatus were significantly reduced in the bupivacaine plus ketamine and midazolam group. Conclusion In a population of frail, elderly patients, thoracic continuous spinal anesthesia with local anesthetic plus midazolam and ketamine was superior to local anesthetic plus fentanyl. In the group receiving local anesthetic plus midazolam and ketamine, the incidence of respiratory depression was reduced, and doses of norepinephrine and intraoperative sedating medications were lower. Intraoperative anesthesia and postoperative analgesia were similar in both groups.

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“…Local recurrence was observed in 7 (8.3%) patients, 4 (Jiang et al, 2009). However, compared with younger patients, most elderly patients have cardiovascular or pulmonary diseases and have reduced functional reserve, which increases the risk of surgery and morbidity (Hentati et al, 2018). Several multicenter randomized controlled trials have compared the efficacy of laparoscopic surgery and open surgery in the treatment of colon/rectal cancer.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of Laparoscopic Versus Open Surgery in Elderly Patients with Rectal Cancer

Zhang

Liang

Chen

et al. 2021

Asian Pac J Cancer Prev

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Background: Laparoscopic colorectal resection has been gaining popularity over the past two decades-and the number of elderly patients with colorectal cancer treated with a surgical modality has gradually increased. However, studies about laparoscopic rectal surgery in elderly patients with long-term oncologic outcomes are limited. In this study, we evaluated the safety and effectiveness of laparoscopic resection in patients with rectal cancer aged ≥80 y. Methods: From 2007-2015, a total of 84 consecutive patients with rectal cancer from a single institution were included, 45 patients undergoing laparoscopic rectal resection were compared with 39 patients undergoing open rectal resection. Results: The two groups were well balanced in terms of age, gender, body mass index, American society of anesthesiologists scores, previous abdominal surgery, neoadjuvant therapy, tumor stage, distance of tumor from the anal verge, and comorbidities. One (2.2%) patient in the laparoscopic group required conversion to open surgery. Laparoscopic surgery was associated with significantly longer operating time (160.1±28.2 versus 148.2±41.3 min; P=0.031), less intraoperative blood loss (80.5±20.9 versus 160.3±42.4 mL; P=0.002), less need of blood transfusion (6.7% versus 20.5%; P=0.003), a shorter time to diet recovery (2.5±1.5 versus 4.9±1.1; P=0.015) and postoperative hospital stay (7.5±4.5 versus 10.8±4.2; P=0.035), lower overall postoperative complication rate (8.9% versus 20.5%; P=0.017), and wound-related complication rate (4.4% versus 10.2%; P=0.013) when compared with open surgery. Specimen length, no. of retrieced lymph nodes, positive distal and circumferential margin rate, mortality rate, and reoperation rate were not significantly different between two groups. The disease-free and overall 5-year survival rates were similar between two groups.Conclusions: Laparoscopic rectal surgery is safe and feasible in patients aged≥80 y and is associated with similar long-term oncologic outcomes when compared with open surgery.

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Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies

Abstract: The decision to perform abdominal surgery in the emergency setting should be based on physiological status, which accounts for a patient's comorbidities and health status, rather than on chronological age per se.

Cited by 11 publications

References 42 publications

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

Outcomes of Laparoscopic Versus Open Surgery in Elderly Patients with Rectal Cancer

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