title: After-hours urgent and emergent surgery in the elderly: outcomes and prognostic factors.
abstract: Surgeons are becoming increasingly involved in the care of elderly patients. The purpose of this project was to evaluate contemporary outcomes of emergent surgeries performed after hours in elderly patients and to determine any risk factors for poor outcome. We retrospectively reviewed  patients 80 years or older undergoing an urgent or emergent surgery at our medical center from 6 pm to 6 am from October 2006 through July 2009. Comparisons were made between survivors and nonsurvivors using Wilcoxon rank sum and Fisher exact test when indicated. P < 0.05 was considered  significant. During the study period, 59 patients met inclusion criteria; the average age was 84 years (range, 80 to 102 years). A total of 70 procedures were performed; the most common were colectomy (18), small bowel resection (13), lysis of adhesions (9), and gastric surgery (8). The majority  of patients were female (68%) with 47 per cent and 53 per cent of patients undergoing emergent and urgent surgery, respectively. Sixty-seven complications occurred in 38 patients; the morbidity rate was 64 per cent, and the mortality rate was 25 per cent. The only studied factors significantly  associated with mortality were higher American Society of Anesthesiologists score (P = 0.004), increased intravenous fluids (P = 0.03), decreased intraoperative urine output (P = 0.03), and the need for intraoperative blood (P = 0.003). After-hours urgent and emergent  surgery in the elderly has a high morbidity and mortality rate. We identified several risk factors for a poor prognosis that may be useful to the surgeon when discussing the patient's prognosis with the family.
authors.affiliation: South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina. USA.
authors.forename: Devan
authors.initials: D
authors.lastname: Griner
authors.forename: Ashley
authors.initials: A
authors.lastname: Adams
authors.forename: Cyrus A
authors.initials: CA
authors.lastname: Kotwall
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Clancy
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
mesh_terms: D000046:Academic Medical Centers; D039602:After-Hours Care; D000367:Age Factors; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality*; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013514:Surgical Procedures, Operative / Q000379:methods / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome