title: Emergency general surgery in the geriatric patient.
abstract: BACKGROUND
  Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care.
  
  
  METHODS
  This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient.
  
  
  RESULTS
  The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care.
  
  
  CONCLUSIONS
  Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
authors.forename: K F
authors.initials: KF
authors.lastname: Desserud
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Veen
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Søreide
mesh_terms: D016223:Advance Directives / Q000941:ethics; D000368:Aged; D004638:Emergency Treatment / Q000941:ethics / Q000379:methods*; D004992:Ethics, Medical; D005544:Forecasting; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D018447:Medical Futility; D010166:Palliative Care / Q000941:ethics / Q000379:methods; D010347:Patient Care Planning; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000941:ethics / Q000379:methods*