title: Increased mortality in the elderly after emergency abdominal surgery.
abstract: BACKGROUND
  The purpose of this study was to evaluate the relation between preoperative delay and mortality in surgical patients undergoing primary emergency laparotomy (PEL) in an unselected, well-described patient cohort in a university hospital setting.
  
  
  METHODS
  This study was a retrospective analysis of patient charts and perioperative documentation in an unselected consecutive cohort of 131 patients. Covariates for survival outcomes were evaluated in a multivariate analysis. No external funding and no competing interests were declared. The study was approved by The Danish Data Protection Agency; and in pursuance of national Danish research guidelines concerning retrospective studies, approval from ethics committee was not relevant.
  
  
  RESULTS
  PEL was performed in 131 patients in the observation period. The median age of the patients was 68 years. The median time from admission to start of operation for all patients was 9.5 hours. No association between a time to operation exceeding six hours and post-operative mortality was found (adjusted odds ratio (95% confidence interval) = 0.67 (0.25-1.78)). Patients over 75 years of age had a very high mortality (47.8%). Most patients died within 30 days post-operatively.
  
  
  CONCLUSIONS
  Acute admission and emergency laparotomy is associated with a very high mortality, especially in elderly patients. However, delay in the surgical treatment exceeding six hours is not associated with a higher mortality. There may be a considerable potential for improving care and management in these patients through a more systematic approach.
authors.affiliation: Gastroenheden, Hvidovre Hospital, Kettegård Alle 30, 2650 Hvidovre, Denmark. d364584@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Svenningsen
authors.forename: Thukirtha
authors.initials: T
authors.lastname: Manoharan
authors.forename: Nicolai B
authors.initials: NB
authors.lastname: Foss
authors.forename: Morten L
authors.initials: ML
authors.lastname: Lauritsen
authors.forename: Morten
authors.initials: M
authors.lastname: Bay-Nielsen
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality* / Q000601:surgery*; D007416:Intestinal Perforation / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D061665:Time-to-Treatment; D055815:Young Adult