title: Emergency Major Abdominal Surgical Procedures in Older Adults: A Systematic Review of Mortality and Functional Outcomes.
abstract: OBJECTIVE
  To systematically review the current literature on mortality and functional outcomes after emergency major abdominal surgery in older adults.
  
  
  METHODS
  Systematic literature search and standardized data collection of primary research publications from January 1994 through December 2013 on mortality or functional outcome in adults aged 65 and older after emergency major abdominal surgery using PubMed, EMBASE, Web of Science, Cochrane, and CINAHL. Bibliographies of relevant reports were also hand-searched to identify all potentially eligible studies.
  
  
  METHODS
  Systematic review of retrospective and cohort studies using Preferred Reporting Items for Systematic reviews and Meta-Analyses, Meta-analysis Of Observational Studies in Epidemiology, Strengthening the Reporting of Observational Studies in Epidemiology, and A Measurement Tool to Assess Systematic Reviews guidelines.
  
  
  METHODS
  Older adults.
  
  
  METHODS
  Articles were assessed using a standardized quality scoring system based on study design, measurement of exposures, measurement of outcomes, and control for confounding.
  
  
  RESULTS
  Of 1,459 articles screened, 93 underwent full-text review, and 20 were systematically reviewed. In-hospital and 30-day mortality of all older adults exceeded 15% in 14 of 16 studies, where reported. Older adults undergoing emergency major abdominal surgery consistently had higher mortality across study settings and procedure types than younger individuals undergoing emergency procedures and older adults undergoing elective procedures. In studies that stratified older adults, odds of death increased with age. None of these studies examined postoperative functional status, which precluded including functional outcomes in this review. Differences in exposures, outcomes, and data presented in the studies did not allow for quantification of association using metaanalysis.
  
  
  CONCLUSIONS
  Age independently predicts mortality after emergency major abdominal surgery. Data on changes in functional status of older adults who undergo these procedures are lacking.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.|Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.|Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: John W
authors.initials: JW
authors.lastname: Scott
authors.affiliation: Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Ronnie A
authors.initials: RA
authors.lastname: Rosenthal
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
keywords: emergency surgery; functional status; mortality; postoperative complications