Working Collaboratively: Outcomes of Geriatrician Input in Older Patients Undergoing Emergency Laparotomy in a District General Hospital

Geriatric Patients Undergoing Outpatient Surgery in the United States: A Retrospective Cohort Analysis on the Rates of Hospital Admission and Complications

INTRODUCTION

 This study is a retrospective cohort analysis that describes key clinical outcomes in elderly individuals who undergo outpatient surgical procedures. In particular, we report same-day admission, 30-day mortality, 30-day complications, and 30-day readmission rates for three separate age groups undergoing frequent outpatient, general surgical procedures.

METHODS

Patients ≥18 years old who underwent the 10 most common outpatient surgical procedures in the National Surgical Quality Improvement Program database from 2017 to 2019 and who underwent general anesthesia were included in the study. The primary outcome of interest was hospital admission, defined as hospital length of stay >0 days. Secondary outcomes of interest included 30-day readmission, 30-day mortality, and 30-day postoperative complications. The primary exposure variable of interest was age, which was divided into <65 years of age (reference cohort), 65-79 years of age, and ≥80 years of age. For univariate analysis, to measure differences in the outcomes and patient characteristics, we used chi-squared tests. Our primary method of analysis was multivariable logistic regression.

RESULTS

Those who were ≥80 and 65-79 years of age compared to <65 years of age had higher odds of same-day admission, 30-day mortality, composite postoperative complications, and readmission. Patients who were ≥80 years old had higher odds of same-day admission for laparoscopic cholecystectomy, partial mastectomy, laparoscopic inguinal hernia repair, inguinal hernia repair, umbilical hernia repair, laparoscopic removal of adnexal structures, and lumbar laminotomy.

CONCLUSION

Increasing age, particularly greater than 80 years or older and 65-79 years of age group, is associated with an increased rate of same-day hospital admissions and complications after ambulatory surgery.

Risk indices that predict in-hospital mortality of elderly patients

Background/aim

Mortality in the elderly population tends to be higher than in all other age groups; the risk factors that predict mortality among those in this age cohort are not fully understood. This large-scale clinical study aimed to identify effective risk factors that predict mortality in the elderly population with a particular focus on age and hospitalization status.

Material and methods

We retrospectively analyzed outcomes from patients with clinical follow-up between July 2015 and January 2020 at 29 Mayıs State Hospital, Ankara, Turkey. Patient records with missing or ambiguous data were excluded. Age, sex, length of hospital stay, comorbidities, consultation requests and diagnoses that include infectious diseases were evaluated for their role in predicting in-hospital mortality using binary logistic regression analysis. Primary outcomes focused on factors that had an impact on overall in-hospital mortality in the elderly population.

Results

Our study included 11,430 patients; of this group, 39.9% were elderly, which we defined as 65 years of age or older. Risk factors for in-hospital mortality in this cohort included consultation requests (AOR = 1.95, CI (1.53–2.49), P < 0.001) and length of hospital stay of ≥4 days (AOR = 2.49, CI (1.90–3.26), P < 0.001).

Conclusion

Elderly patients are at significantly higher risk for in-hospital mortality than are younger patients. Among the factors that may be used to predict the risk of in-hospital mortality in the elderly patient cohort, the most important factor is the length of hospital stay.