Mortality Associated with Emergency Abdominal Surgery in the Elderly

Introduction: Elderly patients with life-threatening abdominal disease are undergoing emergency surgery in increasing numbers, but emergency procedures generally are associated with increased morbidity and mortality. We carried out a retrospective and prospective study at a tertiary centre in Spain to analyze the factors contributing to death after emergency abdominal surgery in elderly patients and to determine whether there were differences in the death rate between those aged 70-79 years and those aged 80 years and older.

Methods: The study population comprised 710 patients aged 70 years or older who underwent emergency surgery for intra-abdominal disorders. Between 1986 and 1990, we reviewed the charts of 302 patients, and between 1991 and 1995, we collected prospective data on 408 patients. The patients were divided by age into 2 groups: group 1 - 364 patients aged 70-79 years; and group 2 - 346 patients aged 80 years or older. In the analysis, we considered patient age, sex, perioperative risk, the time between onset of symptoms and admission to hospital and between admission to hospital and surgery, diagnosis, type of operation, operative findings, morbidity, mortality and length of hospital stay.

Results: The overall mortality was 22% (19% in group 1 and 24% in group 2). Multiple regression analysis showed that American Society of Anesthesiologists (ASA) grading (p = 0.0001), interval from onset of symptoms to admission (p = 0.007), mesenteric infarction (p = 0.005), a defunctioning stoma and palliative bypass (p = 0.003) and nontherapeutic laparotomy (p = 0.0003) were predictive of death.

Conclusions: Mortality in elderly patients operated on for an acute abdomen can be predicted by ASA grade (perioperative risk), delay in surgical treatment and conditions that permit only palliative surgery. Increasing age (70-79 yr or > or = 80 yr) does not affect mortality, morbidity or length of hospital stay.