title: Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: A single center experience.
abstract: OBJECTIVE
  To determine predisposing factors leading to surgical delay in elderly patients with acute abdominal conditions and its impact on surgical outcomes.
  
  
  METHODS
  A retrospective review of a total of 144 patients aged 60 years and older who had undergone emergency abdominal surgery between 2010 and 2013 at a regional general hospital was analysed. The operations analysed were limited to perforated or gangrenous viscus and strangulated hernia. Patient demographic features, time taken to obtain a computed tomography scan, time taken to surgery and the impact on postoperative morbidity and mortality were analysed.
  
  
  RESULTS
  The mean age was 70.5 ± 9.1 years and median time taken to surgery was 9 h. The overall mortality and complication rates (Clavien Dindo 3 and above) were 9% and 13.1% respectively. Diabetes mellitus was a significant predisposing factor which had an impact on surgical delays. Delays in surgery more than 24 h led to higher complication rates at 38.9% (P = 0.003), with multivariate analysis confirming it as an independent factor. Delays in obtaining a computed tomography (CT) scan was also shown to result in higher complication rates (Clavien Dindo 3 and above).
  
  
  CONCLUSIONS
  Delays in performing emergency surgery in elderly lead to higher complication rates. Obtaining CT scans early also may facilitate prompt diagnosis of certain abdominal emergencies where presentation is more equivocal and this may lead to improved surgical outcomes.
authors.affiliation: Marc Ong, Tan Yu Guang, Tan Kok Yang, Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore.
authors.forename: Marc
authors.initials: M
authors.lastname: Ong
authors.affiliation: Marc Ong, Tan Yu Guang, Tan Kok Yang, Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore.
authors.forename: Tan Yu
authors.initials: TY
authors.lastname: Guang
authors.affiliation: Marc Ong, Tan Yu Guang, Tan Kok Yang, Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore.
authors.forename: Tan Kok
authors.initials: TK
authors.lastname: Yang
keywords: Delay; Elderly; Emergency; Outcomes; Surgery