ThE Prognostic Role of Comorbidities in Older Patients Qualified for Emergency Abdominal Surgery

• Authors: Jakub Kenig , Piotr Richter , Urszula Olszewska , Beata Żychiewicz
• Languages of publication: EN

Abstracts

EN

Until now, the literature about the influence of specific comorbid conditions on outcome of emergency abdominal surgery in polish elderly patients is scars.The aim of the study was to determine the prognostic role of comorbidities in patients qualified for emergency abdominal surgery.Material and methods. One hundred and eighty four consecutive patients(98 female and 86 male). 65 years of age were prospectively enrolled. The mean age was 76.9±5.8 (range 65-100) years old.Results. Only 16% of patients did not have any preoperative comorbidity. The 30-day mortality was 24.5% (45 patients). The 30-day morbidity was experienced by the 58.7% (108 patients), including 40 patients (21.7%) with minor complications and 68 patients (37%) with major complications, according to the Clavien-Dindo complications scale.The dysrhythmia (odds ratio 1.6, 95% CI 1.2-2.6, p=0.02), vascular disease (odds ratio 2.1, 95% CI 1.4- 3.1, p=0.02) and renal disease (odds ratio 1.4, 95% CI 1.2-2.8, p=0.01) were independent risk factors of 30-day morbidity. The vascular disease was also the independent risk factor of 30-day postoperative death in the multivariate regression analysis (odds ratio 1.9, 95% CI 1.3-2.8, p=0.001).Conclusions. Preoperative comorbidities are common among elderly patients qualified for emergency abdominal surgery. However, only some of them (the dysrhythmia, the vascular disease and the renal disease) are independent risk factors of postoperative adverse outcomes. Therefore, number of comorbidies alone should not be the reason for a limited treatment.

Keywords

EN

emergency surgery; comorbidities; older patients

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2015
• Volume: 86
• Issue: 12
• Pages: 569-575

Dates

online

1 - 3 - 2015

received

13 - 10 - 2014

Contributors

author

Jakub Kenig

• 3rd Department of General Surgery, Jagiellonian University Collegium Medicum in Cracow Kierownik: prof. dr hab. W. Nowak

author

Piotr Richter

• 3rd Department of General Surgery, Jagiellonian University Collegium Medicum in Cracow Kierownik: prof. dr hab. W. Nowak

author

Urszula Olszewska

• 3rd Department of General Surgery, Jagiellonian University Collegium Medicum in Cracow Kierownik: prof. dr hab. W. Nowak

author

Beata Żychiewicz

• 3rd Department of General Surgery, Jagiellonian University Collegium Medicum in Cracow Kierownik: prof. dr hab. W. Nowak

References

• 1. Charles F: Surgical considerations in the elderly. In: F. Charles Brunicardi, Dana Anderson, Timothy Billiar, David Dunn, John Hunter, Raphael Pullock, eds. Schwartz's Principles of Surgery. 9th ed. New York: McGraw-Hill Companies, Inc; 2010: 4088-91.
• 2. Leung JM, Dzankic S: Relative Importance of Preoperative Health Status Versus Intraoperative Factors in Predicting Postoperative Adverse Outcomes in Geriatric Surgical Patients. Am Geriatr Soc 2001; 49: 1080-85.[Crossref]
• 3. Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-83.
• 4. Fukuda N, Wada J, Niki M et al.: Factors predicting mortality in emergency abdominal surgery in the elderly. World J of Emerg Surg 2012; 7 12.[Crossref][WoS]
• 5. Feny G: Acute abdominal disease in the elderly. Am J Surg 1982; 143: 751-54.[Crossref]
• 6. Mcintyre R, Reinbach D, Cuschieri RJ: Emergency abdominal surgery in the elderly. J R Coll Surg Edinb 1997; 42: 173-78.[PubMed]
• 7. Ozkan E, Fersahog.lu MM, Dulundu E et al.: Factors affecting mortality and morbidity in emergency abdominal surgery in geriatric patients. Ulus Trauma Acil Cerrahi Derg 2010; 16: 439-44.
• 8. Kettunen J, Paajanen H, Kostiainen S: Emergency abdominal surgery in the elderly. Hepatogastroenterol 1995; 42: 106.08.
• 9. Arenal JJ, Bengoechea-Beeby M: Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 2003; 46: 111-16.[PubMed]
• 10. Costamagna D, Pipitone Federico NS, Erra S et al.: Acute abdomen in the elderly. A peripheral general hospital experience. G Chir 2009; 30: 315-22.[PubMed]
• 11. Liu L, Leung J: Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc 2000; 48: 405-12.[PubMed]
• 12. Janssen-Heijnen M, Maas H, Houterman S et al.: Comorbidity in older surgical cancer patients: Influence on patient care and outcome. European Journal Of Cancer 2007; 43: 2179-93.[Crossref]
• 13. Rubinfeld I, Thomas C, Berry S et al.: Octogenarian abdominal surgical emergencies: Not so grim a problem with the acute care surgery model? J Trauma 2009; 67: 983-89.[WoS][Crossref]
• 14. McDermott FD, Collins D, Heeney A, Winter DC: Minimally invasive and surgical management strategies tailored to the severity of acutediverticulitis. Br J Surg 2014; 101(1): 90-99.
• 15. Gurusamy KS, Rossi M, Davidson BR: Percutaneous cholecystostomy for high-risk surgical patients with acute calculouscholecystitis. Cochrane Database Syst Rev. 2013; 12(8): doi: 10.1002/14651858.CD007088.pub2[WoS][Crossref]
• 16. Cirocchi R, Farinella E, Trastulli S et al.: Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol 2013 22(1): 14-21.[PubMed][Crossref][WoS]
• 17. Kreis ME, Mueller MH, Thasler WH: Hartmann's procedure or primary anastomosis? Dig Dis. 2012; 30(1): 83-85.[Crossref][WoS]

Identifiers

DOI

10.1515/pjs-2015-0003