title: Emergency Abdominal Operations in the Elderly: A Multivariate Regression Analysis of 430 Consecutive Patients with Acute Abdomen.
abstract: BACKGROUND
  This study is intended to ascertain if outcome of acute abdominal surgery among elderly patients with acute abdominal pain have improved.
  
  
  METHODS
  Altogether 456 patients aged >65 years underwent emergency abdominal surgery between the years 2007 and 2009 in our hospital. After excluding emergency reoperations of elective surgery, a total of 430 consecutive patients were included in this retrospective audit. The key factors under analysis in this study were the occurrence of major complications and death from any cause within 30 days after the operation. In addition, we compared our results to our previously published data some 20 years ago.
  
  
  RESULTS
  The most common diagnoses were cholecystitis (n = 139, 32.3 %, incidence of 125 per 100,000 elderly persons), incarcerated hernia (n = 60, 13.9 %, 54/100,000), malignancy related (n = 50, 11.6 %, 45/100,000), or acute appendicitis (n = 46, 10.7 %, 41/100,000). The majority of operations (80.7 %) were performed using open technique. Of all 112 laparoscopic procedures, 25.9 % were converted to open surgery. Reoperations were rare and postoperative surgical complications were not associated with statistically significant increase in mortality, even if reoperation was needed. The 30-day mortality and morbidity rates were 14.2 and 31.9 %, respectively. Logistic regression analysis showed that patient's age (p = 0.014), atrial fibrillation (p = 0.017), low body mass index (p = 0.001), open surgery (p = 0.029), ASA grade III or more (p < 0.001), and previous history of malignancies (p = 0.010) were likely to increase mortality.
  
  
  CONCLUSIONS
  Despite modern diagnostics and improved surgical techniques, the results of emergency abdominal surgery still have relatively high morbidity and mortality as reported in earlier studies.
authors: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. mika.ukkonen@fimnet.fi.|Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland. mika.ukkonen@fimnet.fi.
authors: Mika
authors: M
authors: Ukkonen
authors: Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland. antti.kivivuori@esshp.fi.
authors: Antti
authors: A
authors: Kivivuori
authors: Department of Gastrointestinal Surgery, University of Eastern Finland, Kuopio, Finland. tuomo.rantanen@kuh.fi.
authors: Tuomo
authors: T
authors: Rantanen
authors: Department of Gastrointestinal Surgery, University of Eastern Finland, Kuopio, Finland. hannu.paajanen@kuh.fi.
authors: Hannu
authors: H
authors: Paajanen
mesh_terms: D000005:Abdomen / Q000601:surgery; D000006:Abdomen, Acute / Q000601:surgery*; D000008:Abdominal Neoplasms / Q000601:surgery; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000601:surgery; D002764:Cholecystitis / Q000601:surgery; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004630:Emergencies; D005260:Female; D005387:Finland; D046449:Hernia, Abdominal / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies