title: Advanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis.
abstract: BACKGROUND
  The objectives of our study were to determine the association between age and postoperative outcomes after emergency surgery for diverticulitis and to identify risk factors for postoperative mortality among elderly patients.
  
  
  METHODS
  All patients from the American College of Surgeons National Surgical Quality Improvement Program 2005-2009 Participant User Files undergoing emergent surgery for diverticulitis were included. Multivariate logistic regression was used to determine the association between age and postoperative morbidity and mortality after adjustment for perioperative variables. A separate regression model was used to determine risk factors for postoperative mortality among elderly patients, with specific postoperative complications being included as potential predictors.
  
  
  RESULTS
  We included 2,264 patients for analysis, of whom 1,267 (56%) were <65 years old (nonelderly), 648 (28.6%) were 65-79 years old (elderly), and 349 (15.4%) were ≥80 years old (super-elderly). Advanced age was a significant predictor of 30-day postoperative mortality, and to a lesser extent postoperative morbidity. Among those patients ≥65 years old, super-elderly age classification remained a significant predictor of mortality after adjustment for the presence or absence of postoperative complications. Mortality among elderly and super-elderly patients was greatest in the setting of specific complications, such as septic shock, prolonged postoperative mechanical ventilation, and acute renal failure.
  
  
  CONCLUSIONS
  Advanced age is an independent risk factor for death after emergency surgery for diverticulitis, with mortality being greatest among elderly patients who experience certain postoperative complications. Prevention of these complications should form the cornerstone of initiatives designed to lower the mortality associated with emergency surgery in elderly patients.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. michael.lidsky@duke.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lidsky
authors.forename: Julie K Marosky
authors.initials: JK
authors.lastname: Thacker
authors.forename: Sandhya A
authors.initials: SA
authors.lastname: Lagoo-Deenadayalan
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004238:Diverticulitis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology*; D012044:Regression Analysis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome