The acute surgical admission: is mortality predictable in the elderly?
Most scoring systems used to predict mortality are complex. A simple preoperative assessment, the Sickness Assessment (SA), was evaluated as a predictor of mortality in elderly patients admitted as surgical emergencies. The three parameters comprising the SA are: hypotension on admission, the presence of severe chronic disease, whether the patient was independent and self-caring. Prospectively, 487 consecutive patients of over 65 years of age admitted as surgical emergencies were studied. On admission, the SA and the APACHE II score were calculated. Hospital mortality was used as the endpoint. Of 309 patients with zero SA, 21 (7%) died. In 178 with a positive SA, 64 died (36%) (chi 2 = 64.6, P < 0.001). After laparotomy, mortality was 57% (36/67) with a positive SA, but 15% (15/103) with a zero assessment (chi 2 = 33.6, P < 0.001). When the single parameter of hypotension on admission was present, mortality was 77% (23/30). The predictive ability of the APACHE II score was not superior to SA. The SA is a simple preoperative assessment which identifies a high-risk group. It should be used in emergency surgical practice to improve outcome and avoid inappropriate surgery.
Bristol Royal Infirmary.
R H
RH
Kennedy
R A
RA
al-Mufti
S F
SF
Brewster
E N
EN
Sherry
T R
TR
Magee
T T
TT
Irvin
D000208:Acute Disease; D000368:Aged; D002908:Chronic Disease; D004630:Emergencies; D006801:Humans; D007813:Laparotomy / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D012648:Self Care; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000401:mortality*