A. A. Haider1, P. Rhee1, N. Kulvatunyou1, T. O’Keeffe1, A. Tang1, R. Latifi1, G. Vercruysse1, J. Mohler1, M. Fain1, B. Joseph1 1University Of Arizona,Trauma Surgery,Tucson, AZ, USA
Introduction:
Emergency general surgery (Acute appendicitis, cholecystitis, and diverticulitis) remains one of the most common diagnoses seen by general surgeons. As the US population ages, the number of geriatric patients that present with this diagnosis is also on the rise. The aim of this study was to determine if hospitals that manage higher proportion of geriatric patients have better outcomes.
Methods:
The National Inpatient Sample was abstracted for all geriatric patients (≥ 65 years) with a diagnosis of acute appendicitis, cholecystitis, or diverticulitis from the years 2004 to 2011. Only hospitals with annual EGS volume of ≥ 500 patients were included. Hospitalized were categorized into 5 groups by the proportion of geriatric EGS patients seen. Multivariate regression models and observed-expected ratios were used to calculate the risk-adjusted mortality rates (RAMR) and risk-adjusted failure-to rescue rates (RAFTR).
Results:
A total of 253,800 patients from 817 hospitals were included. Mean age was 76.9 ± 7.8 years, 40.0% were male, and mean Charlson Comorbidity Index was 1.03 ±1.4. Overall mortality rate was 3.2% and failure-to-rescue rate was 2.4%. Geriatric patients had 43% lower odds of mortality (OR, 0.57; 95% CI, 0.43–0.76), and 49% lower odds of failure-to-rescue (OR, 0.51; 95% confidence interval, 0.37–0.71) if they are treated at centers managing a high proportion of geriatric EGS cases.
Conclusion:
Geriatric patients who are managed at hospitals that manage a higher proportion of geriatric patients have better outcomes. These findings supports the idea for the need of specialized geriatric centers that handle predominantly geriatric surgical cases.
