Early predictors for tissue healing deficit and leakage in geriatric critically ill patients receiving emergent abdominal surgery: a case control study.
BACKGROUND
As our world ages and the elderly population grows. Surgery on the aged critically ill tend to result in additional morbidity and mortality. We sought to determine early predicting factors that were associated with postoperative leakage and tissue healing deficiency after emergent abdominal surgery in geriatric critically ill patients.


METHODS
Retrospectively, geriatric critically ill patients received anticipated, single-stage emergent abdominal surgery via emergency room were enrolled. Patients who received only one definitive surgery during their hospital course were labeled as group A, patients received anticipated one-stage surgery and eventually with postoperative leakage and tissue healing deficiency were labeled as group B. The demographics and parameters were obtained for comparison.


RESULTS
There were 45 patients in group A, and 34 patients in group B. The mean age is 77.4 ± 6.1 years in Group A and 76.9 ± 8.5 years in Group B, the mean APACHE score was 20.3 ± 7.5 vs. 21.6 ± 7.7. There were no significances in age, gender, comorbidities, and physiological scores. There were significances in the persistent post-operative use of vasopressors and hypoalbuminemia. The 30-day mortality rate was 0% in group A and 38.2% in group B.


CONCLUSIONS
Persistent post operative vasopressor use and hypoalbuminemia are associated with higher rate of morbidity and mortality after emergent abdominal surgery in geriatric critically ill patients. Early recognition is essential for proper management. Further studies are required for a better understanding in identifying risk factors.
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: rw114@mail.cmuh.org.tw.
Shih-Chi
SC
Wu
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linko, Taiwan. Electronic address: drfu5564@yahoo.com.tw.
Chih-Yuan
CY
Fu
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: hsiehchihsun@yahoo.com.tw.
Chi-Hsun
CH
Hsieh
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: traumawang@yahoo.com.tw.
Yu-Chun
YC
Wang
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: carfishcat@yahoo.com.tw.
Hung-Chieh
HC
Lo
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: howardcheng324@gmail.com.
Han-Tsung
HT
Cheng
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: D11814@mail.cmuh.org.tw.
Chia-Wei
CW
Tzeng
D000005:Abdomen / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016638:Critical Illness; D005260:Female; D005853:Geriatrics / Q000379:methods*; D006801:Humans; D007813:Laparotomy; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012086:Reoperation; D014945:Wound Healing
Geriatric critical ill; Hypoalbuminemia; Vasopressor