title: Predictors of in-hospital mortality amongst octogenarians undergoing emergency general surgery: a retrospective cohort study.
abstract: BACKGROUND
  Elderly patients are often judged to be fit for emergency surgery based on age alone. This study identified risk factors predictive of in-hospital mortality amongst octogenarians undergoing emergency general surgery.
  
  
  METHODS
  A retrospective review of octogenarians undergoing emergency general surgery over 3 years was performed. Parametric survival analysis using Cox multivariate regression model was used to identify risk factors predictive of in-hospital mortality. Hazard ratios (HR) and corresponding 95% confidence interval were calculated.
  
  
  RESULTS
  Seventy-three patients with a median age of 84 years were identified. Twenty-eight (38%) patients died post-operatively. Multivariate analysis identified ASA grade (ASA 5 HR 23.4 95% CI 2.38-230, p = 0.007) and chronic obstructive pulmonary disease (COPD) (HR 3.35 95% CI 1.15-9.69, p = 0.026) to be the only significant predictors of in-hospital mortality.
  
  
  CONCLUSIONS
  Identification of high risk surgical patients should be based on physiological fitness for surgery rather than chronological age.
authors.affiliation: Department of General Surgery, Medway Maritime Hospital, Windmill Rd, Gillingham, Kent ME7 5NY, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Wilson
authors.affiliation: Department of General Surgery, Medway Maritime Hospital, Windmill Rd, Gillingham, Kent ME7 5NY, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Paul Barrett
authors.affiliation: Department of General Surgery, Medway Maritime Hospital, Windmill Rd, Gillingham, Kent ME7 5NY, UK.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Department of General Surgery, Medway Maritime Hospital, Windmill Rd, Gillingham, Kent ME7 5NY, UK. Electronic address: shirley.chan@medway.nhs.uk.
authors.forename: Shirley
authors.initials: S
authors.lastname: Chan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: Emergency; General surgery; Mortality; Octogenarian