American journal of surgery · 2018
Outcomes of emergency abdominal surgery in octogenarians: A single-center analysis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Lavanchy Joël L, Holzgang Melanie M, Haltmeier Tobias, Candinas Daniel, Schnüriger Beat
Аннотация
BACKGROUND: The aim of this study was to assess outcomes of octogenarians undergoing emergency abdominal surgery (EAS).
METHODS: Octogenarians undergoing EAS 12/2011-12/2016 were retrospectively analysed. The outcomes were assessed by univariable and multivariable regression analysis.
RESULTS: One-hundred-forty patients with a median age of 83.9 years were included. EAS was performed for cholecystitis (27.1%), ileus (22.1%), hollow viscus perforation (16.4%), diverticulitis (12.9%), mesenteric ischemia (10.0%), incarcerated hernia (9.3%), and appendicitis (2.1%). The overall and early (within 7 days from surgery) mortality rate was 16.4% and 10.0%, respectively. Multivariable analysis revealed age (OR 1.24,CI95% 1.04-1.47,p = 0.015), ASA scores≥4 (OR 11.15,CI95% 2.39-52.02,p = 0.002), mesenteric ischemia (OR 52.60,CI95% 8.93-309.94,p < 0.001) and ICU admission (OR 9.23,CI95% 1.74-49.04,p = 0.009) as independent predictors for mortality. Postoperative withdrawal of care accounted for 36% of early mortalities.
CONCLUSIONS: One third of early mortality in octogenarians was due to postoperative withdrawal of care. An interdisciplinary decision-making including patients' and relatives' wishes may avoid ethically questionable interventions in octogenarians.
METHODS: Octogenarians undergoing EAS 12/2011-12/2016 were retrospectively analysed. The outcomes were assessed by univariable and multivariable regression analysis.
RESULTS: One-hundred-forty patients with a median age of 83.9 years were included. EAS was performed for cholecystitis (27.1%), ileus (22.1%), hollow viscus perforation (16.4%), diverticulitis (12.9%), mesenteric ischemia (10.0%), incarcerated hernia (9.3%), and appendicitis (2.1%). The overall and early (within 7 days from surgery) mortality rate was 16.4% and 10.0%, respectively. Multivariable analysis revealed age (OR 1.24,CI95% 1.04-1.47,p = 0.015), ASA scores≥4 (OR 11.15,CI95% 2.39-52.02,p = 0.002), mesenteric ischemia (OR 52.60,CI95% 8.93-309.94,p < 0.001) and ICU admission (OR 9.23,CI95% 1.74-49.04,p = 0.009) as independent predictors for mortality. Postoperative withdrawal of care accounted for 36% of early mortalities.
CONCLUSIONS: One third of early mortality in octogenarians was due to postoperative withdrawal of care. An interdisciplinary decision-making including patients' and relatives' wishes may avoid ethically questionable interventions in octogenarians.