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Horiuchi A, Akehi S, Fujiwara Y, Kawaharada S, Anai T. Predictors of emergency abdominal surgery for patients aged 90 years or older: A retrospective study. Surg Open Sci 2024; 20:140-144. [PMID: 39092270 PMCID: PMC11292494 DOI: 10.1016/j.sopen.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 08/04/2024] Open
Abstract
Background With the aging of the population, more and more patients ≥90 years old are undergoing surgery. We retrospectively examined factors affecting morbidity and in-hospital mortality among patients ≥90 years old who underwent emergency abdominal operations. Materials and methods Forty-six cases of emergency abdominal surgery for patients ≥90 years old who underwent surgery at our hospital between 2011 and 2022 were included in this study. Factors affecting morbidity and in-hospital mortality were analyzed statistically. Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM)-predicted morbidity and Portsmouth-POSSUM (P-POSSUM)-predicted mortality were calculated. Results Postoperative complications occurred in 30 patients (65.2 %) and 5 patients (10.8 %) died in the hospital. Factors affecting morbidity included American Society of Anesthesiologists physical status score, operative time and blood loss, and operative severity score. Multivariate analysis identified male sex, operative severity score, and length of hospital stay as factors affecting morbidity. Eastern Cooperative Oncology Group performance status and physiological score were identified as factors influencing mortality in hospital, and only physiological score was identified in the multivariate analysis. Area under the receiver operating characteristic (ROC) curve for POSSUM-predicted morbidity was 0.796 and area under the ROC curve for P-POSSUM-predicted mortality was 0.805, both of which were moderately accurate. Conclusion Risk of emergency abdominal surgery in patients ≥90 years old may be predictable to some extent, and we are able to provide convincing explanations to patients and families based on these data.
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Affiliation(s)
- Atsushi Horiuchi
- Department of General Surgery, Ehime Prefectural Niihama Hospital, Japan
| | - Shun Akehi
- Department of General Surgery, Ehime Prefectural Niihama Hospital, Japan
| | - Yuta Fujiwara
- Department of General Surgery, Ehime Prefectural Niihama Hospital, Japan
| | - Sakura Kawaharada
- Department of General Surgery, Ehime Prefectural Niihama Hospital, Japan
| | - Takayuki Anai
- Department of General Surgery, Ehime Prefectural Niihama Hospital, Japan
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Snitkjær C, Rehné Jensen L, í Soylu L, Hauge C, Kvist M, Jensen TK, Kokotovic D, Burcharth J. Impact of clinical frailty on surgical and non-surgical complications after major emergency abdominal surgery. BJS Open 2024; 8:zrae039. [PMID: 38788680 PMCID: PMC11126315 DOI: 10.1093/bjsopen/zrae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Major emergency abdominal surgery is associated with a high risk of morbidity and mortality. Given the ageing and increasingly frail population, understanding the impact of frailty on complication patterns after surgery is crucial. The aim of this study was to evaluate the association between clinical frailty and organ-specific postoperative complications after major emergency abdominal surgery. METHODS A prospective cohort study including all patients undergoing major emergency abdominal surgery at Copenhagen University Hospital Herlev, Denmark, from 1 October 2020 to 1 August 2022, was performed. Clinical frailty scale scores were determined for all patients upon admission and patients were then analysed according to clinical frailty scale groups (scores of 1-3, 4-6, or 7-9). Postoperative complications were registered until discharge. RESULTS A total of 520 patients were identified. Patients with a low clinical frailty scale score (1-3) experienced fewer total complications (120 complications per 100 patients) compared with patients with clinical frailty scale scores of 4-6 (250 complications per 100 patients) and 7-9 (277 complications per 100 patients) (P < 0.001). A high clinical frailty scale score was associated with a high risk of pneumonia (P = 0.009), delirium (P < 0.001), atrial fibrillation (P = 0.020), and infectious complications in general (P < 0.001). Patients with severe frailty (clinical frailty scale score of 7-9) suffered from more surgical complications (P = 0.001) compared with the rest of the cohort. Severe frailty was associated with a high risk of 30-day mortality (33% for patients with a clinical frailty scale score of 7-9 versus 3.6% for patients with a clinical frailty scale score of 1-3, P < 0.001). In a multivariate analysis, an increasing degree of clinical frailty was found to be significantly associated with developing at least one complication. CONCLUSION Patients with frailty have a significantly increased risk of postoperative complications after major emergency abdominal surgery, especially atrial fibrillation, delirium, and pneumonia. Likewise, patients with frailty have an increased risk of mortality within 90 days. Thus, frailty is a significant predictor for adverse events after major emergency abdominal surgery and should be considered in all patients undergoing major emergency abdominal surgery.
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Affiliation(s)
- Christian Snitkjær
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
| | - Lasse Rehné Jensen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
| | - Liv í Soylu
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
| | - Camilla Hauge
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
| | - Madeline Kvist
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
| | - Thomas K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
| | - Dunja Kokotovic
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital—Herlev and Gentofte, Herlev, Denmark
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Chen MZ, Tan M, Walter T, Rich G, Barto W. Colonoscopy in the nonagenarian population. ANZ J Surg 2023; 93:2143-2147. [PMID: 36881524 DOI: 10.1111/ans.18374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND With increasing life expectancy, there is an increasing proportion of nonagenarians undergoing both elective and emergency surgical procedures. The decision as to whom will benefit from surgical procedures is however difficult to ascertain and still remains a challenge to clinicians. This study is aimed to evaluate the clinical outcomes of colonoscopy in the nonagenarian population, and to determine if the outcomes are acceptable for us to continue to offer such interventions. METHODS Retrospective study of patients of Dr. G.R (Gastroenterologist) and Dr. W.B (Colorectal Surgeon) between 1 January 2018 and 31 November 2022. All patients who were ≥90 years old and had a colonoscopy was included in the study. Exclusion criteria were patients who were less than 90 years old, had a flexible sigmoidoscopy or colonoscopy as part of their surgical procedure. PRIMARY OUTCOME MEASURES post-colonoscopy complications and length of stay. SECONDARY OUTCOME MEASURES reasons for colonoscopy, significant colonoscopy findings, 30-day morbidity and mortality. RESULTS Sixty patients were included in the study. Median age was 91 (90-100) years old. 33.3% of the patients were males. Seventy percent of the patients were ASA 3. Median length of hospital stay was 1 day. 11.7% of patients were found to have colorectal malignancy. There were no complications after the colonoscopy. There were no 30-day re-admission, morbidity or mortality. CONCLUSION Colonoscopy can be performed safely in carefully selected nonagenarian patients with acceptable low complication rates.
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Affiliation(s)
- Michelle Zhiyun Chen
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Min Tan
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Tim Walter
- Department of Gastroenterology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Australian National University, Sydney, New South Wales, Australia
| | - Graeme Rich
- Department of Gastroenterology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Australian National University, Sydney, New South Wales, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Walid Barto
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- Department of Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
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Fu H, Zheng J, Lai J, Xia VW, He K, Du D. Risk factors of serious postoperative outcomes in patients aged ≥90 years undergoing surgical intervention. Heliyon 2023; 9:e13117. [PMID: 36747573 PMCID: PMC9898676 DOI: 10.1016/j.heliyon.2023.e13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Objective We aimed to identify preoperative and intraoperative factors associated with serious postoperative outcomes, which may help patients and clinicians make better-informed decisions. Methods We conducted a retrospective study including all patients aged ≥90 years who underwent surgery between January 1, 2011, and January 1, 2021, at Chongqing University Central Hospital. We assessed 30 pre- and intraoperative demographic and clinical variables. Logistic regression was used to identify the independent risk factors for serious postoperative outcomes in patients aged ≥90 years. Results A total of 428 patients were included in our analysis. The mean age was 92.6 years (SD ± 2.6). There were 240 (56.1%) females and 188 (43.9%) males. The most common comorbidities were hypertension (44.9%) and arrhythmias (34.8%). The 30-day hospital mortality was 5.6%, and severe morbidity was 33.2%. Based on the multivariate logistic regression classification analysis of the American Society of Anesthesiologists (ASA)≥ Ⅳ [odds ratio (OR), 5.39, 95% confidence interval (CI), 2.06-14.16, P = .001], emergency surgery (OR, 5.02, 95% CI, 2.85-15.98, P = .001) and chronic heart failure (OR, 6.11, 95% CI, 1.93-13.06, P = .001) were identified as independent risk factors for 30-day hospital mortality, and ASA≥ Ⅳ (OR, 4.56, 95%CI, 2.56-8.15, P < .001), Barthel index (BI) < 35 (OR, 2.28, 95%CI, 1.30-3.98, P = .001), chronic heart failure (OR, 3.67, 95%CI, 1.62-8.31, P = .002), chronic kidney disease (OR, 4.24, 95%CI, 1.99-9.05, P < .001), general anesthesia (OR, 3.31, 95%CI, 1.91-5.76, P < .001), emergency surgery (OR, 3.72, 95%CI, 1.98-6.99, P < .001), and major surgery (OR, 3.44, 95%CI, 1.90-6.22, P < .001) were identified as independent risk factors for serious postoperative complications. Conclusions Patients aged ≥90 years with ASA≥ Ⅳ, BI < 35, combined with chronic heart failure or chronic kidney disease, undergoing emergency surgery, major surgery or general anesthesia have a higher risk of serious postoperative outcomes. Identifying these risk factors in an early stage may contribute to our clinical decision-making and improve the quality of treatments.
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Affiliation(s)
- Hong Fu
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
- Corresponding author. Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, No 1, JianKang Road, Yuzhong District, Chongqing 400014, China.
| | - Jiang Zheng
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jingyi Lai
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Victor W. Xia
- Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Kaiping He
- Division of Medical Record Statistical, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Dingyuan Du
- Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
- Corresponding author. Department of traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing 400014, China.
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Fages A, Soler C, Fernández-Salesa N, Conte G, Degani M, Briganti A. Perioperative Outcome in Dogs Undergoing Emergency Abdominal Surgery: A Retrospective Study on 82 Cases (2018-2020). Vet Sci 2021; 8:vetsci8100209. [PMID: 34679039 PMCID: PMC8540698 DOI: 10.3390/vetsci8100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Emergency abdominal surgery carries high morbidity and mortality rates in human medicine; however, there is less evidence characterising the outcome of these surgeries as a single group in dogs. The aim of the study was to characterise the clinical course, associated complications and outcome of dogs undergoing emergency abdominal surgery. A retrospective study was conducted. Dogs undergoing emergency laparotomy were included in the study. Logistic regression analysis was performed to identify variables correlated with death and complications. Eighty-two dogs were included in the study. The most common reason for surgery was a gastrointestinal foreign body. Overall, the 15-day mortality rate was 20.7% (17/82). The median (range) length of hospitalisation was 3 (0.5-15) days. Of the 82 patients, 24 (29.3%) developed major complications and 66 (80.5%) developed minor complications. Perioperative factors significantly associated with death included tachycardia (p < 0.001), hypothermia (p < 0.001), lactate acidosis (p < 0.001), shock index > 1 (p < 0.001), leukopenia (p < 0.001) and thrombocytopenia (p < 0.001) at admission, as well as intraoperative hypotension (p < 0.001) and perioperative use of blood products (p < 0.001). The results of this study suggest that mortality and morbidity rates after emergency abdominal surgery in dogs are high.
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Affiliation(s)
- Aida Fages
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, University of Pisa, 56122 Pisa, Italy; (M.D.); (A.B.)
- Veterinary Teaching Hospital, Catholic University of Valencia “San Vicente Mártir”, UCV, 46018 Valencia, Spain; (C.S.); (N.F.-S.)
- Correspondence: ; Tel.: +34-659-654-391
| | - Carme Soler
- Veterinary Teaching Hospital, Catholic University of Valencia “San Vicente Mártir”, UCV, 46018 Valencia, Spain; (C.S.); (N.F.-S.)
- Small Animal Medicine and Surgery Department, Catholic University of Valencia “San Vicente Mártir”, UCV, 46018 Valencia, Spain
| | - Nuria Fernández-Salesa
- Veterinary Teaching Hospital, Catholic University of Valencia “San Vicente Mártir”, UCV, 46018 Valencia, Spain; (C.S.); (N.F.-S.)
| | - Giuseppe Conte
- Department of Agriculture, Food and Environment, University of Pisa, 56100 Pisa, Italy;
| | - Massimiliano Degani
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, University of Pisa, 56122 Pisa, Italy; (M.D.); (A.B.)
| | - Angela Briganti
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, University of Pisa, 56122 Pisa, Italy; (M.D.); (A.B.)
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