Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery

Shaheed Merani; Judd Payne; Raj S Padwal; Darren Hudson; Sandy L Widder; Rachel G Khadaroo

doi:10.1186/1749-7922-9-43

Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery

World J Emerg Surg. 2014 Jul 7:9:43. doi: 10.1186/1749-7922-9-43. eCollection 2014.

Authors

Shaheed Merani¹, Judd Payne¹, Raj S Padwal², Darren Hudson³, Sandy L Widder⁴, Rachel G Khadaroo⁵

Affiliations

¹ Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
² Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
³ Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
⁴ Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada ; Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
⁵ Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada ; Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada ; Department of Surgery, University of Alberta, 2D Walter Mackenzie Center, 8440-112 St. NW, Edmonton, Alberta T6G 2B7, Canada.

Abstract

Introduction: With the increasing aging population demographics and life expectancies the number of very elderly patients (age ≥ 80) undergoing emergency surgery is expected to rise. This investigation examines the outcomes in very elderly patients undergoing emergency general surgery, including predictors of in-hospital mortality and morbidity.

Methods: A retrospective study of patients aged 80 and above undergoing emergency surgery between 2008 and 2010 at a tertiary care facility in Canada was conducted. Demographics, comorbidities, surgical indications, and perioperative risk assessment data were collected. Outcomes included length of hospitalization, discharge destination, and in-hospital mortality and morbidity. Multivariable logistic regression was used to identify predictors of in-hospital mortality and complications.

Results: Of the 170 patient admissions, the mean age was 84 years and the in-hospital mortality rate was 14.7%. Comorbidities were present in 91% of this older patient population. Over 60% of the patients required further services or alternate level of care on discharge. American Society of Anesthesiologist Physical Status (ASA) Classification (OR 5.30, 95% CI 1.774-15.817, p = 0.003) and the development of an in-hospital complications (OR 2.51, 95% CI 1.210-5.187, p = 0.013) were independent predictors of postoperative mortality. Chronological age or number of comorbidities was not predictive of surgical outcome.

Conclusions: Mortality, complication rates and post-discharge care requirements were high in very elderly patients undergoing emergency general surgery. Advanced age and medical comorbidities alone should not be the limiting factors for surgical referral or treatment. This study illustrates the importance of preventing an in-hospital complication in this very vulnerable population. ASA class is a robust tool which is predictive of mortality in the very elderly population and can be used to guide patient and family counseling in the emergency setting.

Keywords: Acute care; Elderly; Emergency; Morbidity; Mortality; Surgery.