title: Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis.
abstract: BACKGROUND
  Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery.
  
  
  METHODS
  We conducted a retrospective cohort study of patients aged 65-80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home.
  
  
  RESULTS
  Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) class (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.43-10.33, p = 0.008) and in-hospital complications (OR 1.93, 95% CI 1.32-2.83, p = 0.001). Nearly two-thirds of patients discharged home were younger (OR 0.92, 95% CI 0.85-0.99, p = 0.036), had lower ASA class (OR 0.45, 95% CI 0.27-0.74, p = 0.002) and fewer in-hospital complications (OR 0.69, 95% CI 0.53-0.90, p = 0.007).
  
  
  CONCLUSIONS
  American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home.
authors.affiliation: From the Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Lees, Merani, Khadaroo); and the Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta (Khadaroo), Edmonton, Alta.
authors.forename: Mackenzie C
authors.initials: MC
authors.lastname: Lees
authors.affiliation: From the Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Lees, Merani, Khadaroo); and the Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta (Khadaroo), Edmonton, Alta.
authors.forename: Shaheed
authors.initials: S
authors.lastname: Merani
authors.affiliation: From the Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Lees, Merani, Khadaroo); and the Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta (Khadaroo), Edmonton, Alta.
authors.forename: Keerit
authors.initials: K
authors.lastname: Tauh
authors.affiliation: From the Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Lees, Merani, Khadaroo); and the Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta (Khadaroo), Edmonton, Alta.
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Khadaroo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D004630:Emergencies / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D012044:Regression Analysis; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data