Nonagenarian surgical admissions for the acute abdomen: who benefits?
BACKGROUND
Patients 90 years and older form an increasing proportion of the general population. Outcomes of their acute surgical admissions are not well documented.


METHODS
Surgical management of 49 consecutive nonagenarian admissions (median age: 92 years) with an acute abdomen was compared with the management and outcome of 50 younger patients (median age: 53.5) admitted with a suspected acute abdomen over the same period.


RESULTS
Nonagenarian group consisted of mainly women (71% vs. 50%; p = 0.003). The use of laboratory investigations and imaging was similar for the patients aged over 90 and the younger patients, although proportionately fewer nonagenarians were investigated by abdominal CT scan (8% vs. 24%). Of the 49 nonagenarian patients admitted, only 4% (n = 2) were operated on. In contrast, 38% (n = 19) of patients aged 50-59 (p = 0.0001) underwent a surgical intervention. A much greater proportion of nonagenarians died in hospital than patients in the 50-59 comparator group (16% nonagenarians vs. 4% comparator patients; p = 0.04). The very large majority of survivors in both age groups were discharged back to their preadmission domicile [39 (95%) nonagenarians vs. 46 (96%) comparator 50-59 year group].


CONCLUSIONS
In this study, when compared with younger patients, very few nonagenarian patients (2%) with a suspected acute abdomen benefited from surgical admission. Instead, the large majority of nonagenarians either died or were discharged back to their home address without surgery.
Toumi
Z
Z
Department of Surgery, Royal Preston Hospital, Preston, UK.
Kesterton
A
A
Department of Surgery, Royal Preston Hospital, Preston, UK.
Bhowmick
A
A
Department of Surgery, Royal Preston Hospital, Preston, UK.
Beveridge
A J
AJ
Department of Surgery, Royal Preston Hospital, Preston, UK.
Scott
N A
NA
Department of Surgery, Royal Preston Hospital, Preston, UK.
D000006:Abdomen, Acute / Q000209:etiology / Q000601:surgery*; D000369:Aged, 80 and over / Q000706:statistics & numerical data*; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D016896:Treatment Outcome