As the number of elderly patients continues to increase, emergency abdominal surgery is becoming more common. It is important to evaluate the impact of emergency surgical intervention in this population, especially as such patients have higher rates of comorbidities, limited functional reserves, and a higher need for institutionalized care and rehabilitation, which results in higher rates of mortality and morbidity than the rest of the population. Despite the higher average risk for poor outcomes, the patient’s perioperative conditions play a significant role in determining how well they do after surgery. Several studies have attempted to provide accurate information regarding the risks and benefits of emergency surgery in this age group, but
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In our study, length of hospital stay was found to be protective, perhaps because the monitoring provided after emergency surgery led to timely identification of complications and provided quicker treatment. Fukuda et al. found that delays in admission and an increased time to surgery led to a worst prognosis in elderly patients undergoing emergency abdominal surgery. They contributed the delays in admission and surgery to the difficulty in obtaining an accurate history and the mild character of symptoms in elderly patients who have organ dysfunction due to multiple comorbidities. This can explain why in our study the average time to surgery was high in both cohorts, but significantly lower in the 2007 cohort. As far back as 1998, Khuri et al. analyzed NSQIP data from over 123 medical centres and over 417,000 surgical procedures and found decreased surgical mortality for patients undergoing emergency surgery in the year 1997-1998 when compared to 1994-1995 (after the completion of phase 2 of the step-wise introduction of NSQIP). They attributed these changes to the introduction of the NSQIP program itself as well as improvements in the perioperative process. Interestingly, in this study Khuri found that the biggest predictor of mortality in both emergency and non-emergency surgery was the development of any complication in the 30-days after surgery. Furthermore, improved diagnostic modalities such as CT scans and better triage systems for elderly patients may have contributed to improved access to surgery over the last 15 years and may explain the decreased time to surgery in 2007 compared to
In our study, length of hospital stay was found to be protective, perhaps because the monitoring provided after emergency surgery led to timely identification of complications and provided quicker treatment. Fukuda et al. found that delays in admission and an increased time to surgery led to a worst prognosis in elderly patients undergoing emergency abdominal surgery. They contributed the delays in admission and surgery to the difficulty in obtaining an accurate history and the mild character of symptoms in elderly patients who have organ dysfunction due to multiple comorbidities. This can explain why in our study the average time to surgery was high in both cohorts, but significantly lower in the 2007 cohort. As far back as 1998, Khuri et al. analyzed NSQIP data from over 123 medical centres and over 417,000 surgical procedures and found decreased surgical mortality for patients undergoing emergency surgery in the year 1997-1998 when compared to 1994-1995 (after the completion of phase 2 of the step-wise introduction of NSQIP). They attributed these changes to the introduction of the NSQIP program itself as well as improvements in the perioperative process. Interestingly, in this study Khuri found that the biggest predictor of mortality in both emergency and non-emergency surgery was the development of any complication in the 30-days after surgery. Furthermore, improved diagnostic modalities such as CT scans and better triage systems for elderly patients may have contributed to improved access to surgery over the last 15 years and may explain the decreased time to surgery in 2007 compared to