Emergency Abdominal Surgery in the Elderly: Can We Predict Mortality?

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2016 Oct 27

PMID 27783141

Citations 27

Authors

Anna E Sharrock

Jenny McLachlan

Robert Chambers

Ian S Bailey

James Kirkby-Bott

Affiliations

Soon will be listed here.

Abstract

Background: The United Kingdom population is ageing. Half of patients requiring an emergency laparotomy are aged over 70, 20 % die within 30 days, and less than half receive good care. Frailty and delay in management are associated with poor surgical outcomes. P-POSSUM risk scoring is widely accepted, but its validity in patients aged over 70 undergoing emergency laparotomy is unclear.

Aims: To assess if P-POSSUM risk stratification reliably predicts inpatient mortality in this group and establish whether those who died within 30 days received delayed care.

Methods: Observational study of consecutive patients aged 70 and over fulfilling the National Emergency Laparotomy Audit criteria from a tertiary hospital. The predictive value of pre-operative P-POSSUM, ASA, lactate and other routine variables was assessed. Surgical review, decision to operate, consultant surgical review, antibiotic prescription, laparotomy and discharge or death time points were assessed by 30-day survival.

Results: One hundred and ninety-three patients were included. This represented 46.28 % of those undergoing an emergency laparotomy in our centre. Pre-operative P-POSSUM scoring, ASA grade and lactate were moderate predictors of mortality (AUC 0.784 and 0.771, respectively, lactate AUC 0.705, all p ≤ 0.001). No correlation existed between pre-operative P-POSSUM and days to death (p = 0.209), nor were there delays in key management timings in those who died in 30 days.

Conclusions: P-POSSUM scoring may predict inpatient mortality with moderate discrimination. Addition of frailty scoring in this high-risk group might better identify those with a high risk of mortality after emergency laparotomy and would be a fertile area for further research.

Citing Articles

Comparative evaluation of P-POSSUM and NELA scores in predicting 30-day mortality following emergency laparotomy: A prospective observational study.

Lodha M, Khoth A, N K, Badkur M, Meena S, Banerjee N Turk J Surg. 2025; 41(1):56-60.

PMID: 40012281 PMC: 11878187. DOI: 10.47717/turkjsurg.2025.6645.

Emergency laparotomy preoperative risk assessment tool performance: A systematic review.

Hewitt J, Milton T, Jeanes J, Murshed I, Nann S, Wells S Surg Pract Sci. 2025; 19():100264.

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Predictors of emergency abdominal surgery for patients aged 90 years or older: A retrospective study.

Horiuchi A, Akehi S, Fujiwara Y, Kawaharada S, Anai T Surg Open Sci. 2024; 20:140-144.

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Effect of emergency general surgery on postoperative performance status in patients aged over 90 years.

Harada K, Yamanaka K, Kurimoto M, Aoki H, Shinkura A, Hanabata Y Surg Open Sci. 2024; 17:1-5.

PMID: 38187005 PMC: 10770739. DOI: 10.1016/j.sopen.2023.09.016.

Risk factors for in-hospital mortality after emergency colorectal surgery in octogenarians: results of a cohort study from a referral center.

Mathis G, Lapergola A, Alexandre F, Philouze G, Mutter D, DUrso A Int J Colorectal Dis. 2023; 38(1):270.

PMID: 37987854 PMC: 10663211. DOI: 10.1007/s00384-023-04565-9.

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