J. T. Langford1, M. M. Fleming1, Y. Zhang2,3, J. Luo2, K. Y. Pei1 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 2Yale University School Of Medicine,Section Of Surgical Outcomes And Epidemiology, Department Of Surgery,New Haven, CT, USA 3Yale School of Public Health,Department Of Environmental Health Sciences,New Haven, CT, USA
Introduction: The average age in the US is increasing every year and as the population gets older so does the patient population undergoing surgery. A growing body of literature is urging against using age alone as a risk stratifying tool and to rely on frailty instead. While frailty has been demonstrated as a good predictor of post-operative outcomes in elective surgery it is uncertain whether this holds true for elderly patients undergoing emergency general surgery. The aim of our study was to determine if age alone could be used to predict post-operative outcomes in elderly patients undergoing emergency general surgery.
Methods: Using the ACS-NSQIP database from 2010-2016 we selected patients that underwent 1 of the 7 surgeries that make up 80% of the field emergency general surgery. These include partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy and laparotomy. The primary outcomes measured were overall complication rate and 30 day mortality based on age cohort while controlling for comorbidities and frailty.
Results: 310,643 patients were included in the analysis. Compared to the reference group (age 60-69) there is an increased risk for all complications in the 70-79, 80-89, and ≥ 90 cohorts (OR 1.14 [95%CI 1.11-1.16], OR 1.37 [95%CI 1.34-1.41], OR 1.65 [95%CI 1.57-1.73], respectively). Similarly, there is an increased risk for 30-day mortality (OR 1.47 [95%CI 1.40-1.54], OR 2.37 [95%CI 2.25-2.49], OR 3.69 [95%CI 3.41-3.98], respectively). This trend for increased 30-day mortality is also significant for the 7 procedures individually.
Conclusion: Age can be used as an independent predictor of complications and 30 day mortality in elderly patients undergoing emergency general surgery.