Predictors of in-hospital mortality amongst octogenarians undergoing emergency general surgery: a retrospective cohort study

Int J Surg. 2014 Nov;12(11):1157-61. doi: 10.1016/j.ijsu.2014.08.404. Epub 2014 Sep 16.

Abstract

Introduction: Elderly patients are often judged to be fit for emergency surgery based on age alone. This study identified risk factors predictive of in-hospital mortality amongst octogenarians undergoing emergency general surgery.

Methods: A retrospective review of octogenarians undergoing emergency general surgery over 3 years was performed. Parametric survival analysis using Cox multivariate regression model was used to identify risk factors predictive of in-hospital mortality. Hazard ratios (HR) and corresponding 95% confidence interval were calculated.

Results: Seventy-three patients with a median age of 84 years were identified. Twenty-eight (38%) patients died post-operatively. Multivariate analysis identified ASA grade (ASA 5 HR 23.4 95% CI 2.38-230, p = 0.007) and chronic obstructive pulmonary disease (COPD) (HR 3.35 95% CI 1.15-9.69, p = 0.026) to be the only significant predictors of in-hospital mortality.

Conclusions: Identification of high risk surgical patients should be based on physiological fitness for surgery rather than chronological age.

Keywords: Emergency; General surgery; Mortality; Octogenarian.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Emergencies / epidemiology*
  • Female
  • Hospital Mortality*
  • Humans
  • Incidence
  • Laparotomy / adverse effects*
  • Laparotomy / mortality*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis