Short bowel syndrome in the elderly.
BACKGROUND
The need for massive intestinal resection in the elderly presents an ethical dilemma. The mortality rate for elderly patients who undergo this procedure is high, and quality of life with the short bowel syndrome (SBS) in this group is often questioned. This study evaluated the clinical outcome of patients >70 years of age who underwent intestinal resection leading to SBS.


METHODS
This was a retrospective study of 23 patients ranging in age from 70 to 92 years, who were evaluated over a 20-year period.


RESULTS
There were 11 (48%) early postoperative deaths. Parenteral nutrition (PN) was required for 8 of 12 discharged patients. Five (63%) of the 8 remained on PN permanently, and 3 were transitioned to enteral nutrition (EN). Three patients (PN = 2, EN = 1) died within a year of resection. Four (67%) of 6 patients surviving 5 years received EN only. Five of 10 patients with remnant length <120 cm were discharged, all on PN. PN was later discontinued in 2 patients. Seven (54%) of 13 patients with remnants > 120 cm were discharged; 3 of the 7 remained on PN. Resection was performed for mesenteric vascular disease (n = 13), radiation or cancer (n = 6), and other benign conditions (n = 4). Underlying diagnosis did not influence mortality rate or need for PN. Intestinal continuity was restored in 3 of the 8 patients discharged with an ostomy. Stricturoplasty was performed in 2 patients to improve intestinal function.


CONCLUSIONS
Massive resection in the elderly has a high early mortality rate. Long-term survival is achieved in 50% of discharged patients, especially if they can transition to full EN. Nutritional prognosis is influenced by remnant length more than by underlying disease. Despite their advanced age, these patients are often candidates for further surgical procedures to improve intestinal function.
Thompson
Jon S
JS
Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA. jthompso@unmc.edu