Multifactorial analysis of prognostic factors in emergency abdominal surgery in patients above 80 years. Analysis of 154 consecutive cases.
Patients above 80 have been the most rapidly growing group in the surgical department. The number of major laparotomies in this segment of the population has grown by 15% in the last two decades and is expected to grow by another 100% by the end of the century. The principal aim of the study was to identify by multifactorial analysis the combination of factors predictive of mortality in abdominal emergencies in this age group. A computer-held data base established by the Authors in 1978 was used to register all relevant information in 1327 major laparotomies performed in patients above 70. Of the base of 1327 patients, 219 (16.5%) were above 80. Of this group, 154 cases (70.3%) underwent emergency procedures and are the focus of this study. The principal conclusions of the Authors are as follows: A. The main differences between the two age groups 70-79 (Group A) and above 80 (Group B) are as follows: 1. Emergency laparotomies are much more frequent in Group B (70% versus 33%). 2. The overall mortality is over two and a half times as high (21.4% versus 8%). 3. The diagnostic profile and the mix of cases is different with an increased number of intestinal obstructions and malignancies in Group B. B. Unifactorial analysis of postoperative mortality disclosed the following factors associated with increased mortality: 1. Vital System Category III (Table 6-A). 2. Presence of generalized peritonitis or gangrenous bowel. 3. Presence of widespread malignant disease. 4. Belonging to the following diagnostic groups: carcinoma of pancreas, mesenteric thrombosis. 5. Age 85 or above.(ABSTRACT TRUNCATED AT 250 WORDS)
Reiss
R
R
Department of Surgery B, Beilinson Medical Center, Petah Tiqva, Israel.
Deutsch
A A
AA
Nudelman
I
I
Gutman
H
H
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005767:Gastrointestinal Diseases / Q000401:mortality / Q000601:surgery; D006801:Humans; D007414:Intestinal Neoplasms / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors