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.
Introduction: Acute appendicitis (AA) is the most common indication for emergency surgery and it occurs more often in children and young adults than in patients of advanced age. AA in older patients is a challenging surgical problem because of its atypical presentation. This study was performed to determine whether the age of a patient impacts the outcomes and whether laparoscopic appendectomy (LA) is a feasible method for treatment of patients > 65 years. Material and methods: We performed a retrospective study of 355 patients with AA who were admitted to the Department of General, Minimally Invasive and Elderly Surgery in Olsztyn from 2014 to 2017. The patients were divided into three age groups: 18 to 40, 41 to 65 and >65 years. The histopathological diagnoses were divided into three types: simple AA, phlegmonous AA, and gangrenous AA. Results. LA was performed in 96% of young adults and in 67% of older patients. The patients older than 65 years had higher preoperative white blood cell counts, higher C-reactive protein (CRP) levels and had a longer length of stay (LOS) than younger patients (P=0.05, P=0.03, and P=0.03, respectively). We found a positive correlation among the CRP levels, open appendectomy (OA), and gangrenous appendicitis. Conclusions: Patients older than 65 years more frequently underwent OA than LA, had higher preoperative CRP levels and had a longer LOS than younger patients. Higher CRP levels were associated with a greater risk of gangrenous appendicitis. LA is a safe and feasible treatment method for patients older than 65 years.
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