title: Predictors of Mortality Up to 1 Year After Emergency Major Abdominal Surgery in Older Adults.
abstract: OBJECTIVE
  To identify factors associated with mortality in older adults 30, 180, and 365 days after emergency major abdominal surgery.
  
  
  METHODS
  A retrospective study linked to Medicare claims from 2000 to 2010.
  
  
  METHODS
  Health and Retirement Study (HRS).
  
  
  METHODS
  Medicare beneficiaries aged 65.5 enrolled in the HRS from 2000 to 2010 with at least one urgent or emergency major abdominal surgery and a core interview from the HRS within 3 years before surgery.
  
  
  METHODS
  Survival analysis was used to describe all-cause mortality 30, 180, and 365 days after surgery. Complementary log-log regression was used to identify participant characteristics and postoperative events associated with poorer survival.
  
  
  RESULTS
  Four hundred individuals had one of the urgent or emergency surgeries of interest, 24% of whom were aged 85 and older, 50% had coronary artery disease, 48% had cancer, 33% had congestive heart failure, and 37% experienced a postoperative complication. Postoperative mortality was 20% at 30 days, 31% at 180 days, and 34% at 365 days. Of those aged 85 and older, 50% were dead 1 year after surgery. After multivariate adjustment including postoperative complications, dementia (hazard ratio (HR) = 2.02, 95% confidence interval (CI) = 1.24-3.31), hospitalization within 6 months before surgery (HR = 1.63, 95% CI = 1.12-2.28), and complications (HR = 3.45, 95% CI = 2.32-5.13) were independently associated with worse 1-year survival.
  
  
  CONCLUSIONS
  Overall mortality is high in many older adults up to 1 year after undergoing emergency major abdominal surgery. The occurrence of a complication is the clinical factor most strongly associated with worse survival.
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: Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Gorges
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: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.|James J. Peters Veterans Affairs Medical Center, Bronx, New York.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Kelley
keywords: 1-year mortality; emergency surgery; geriatric surgery; major abdominal surgery; surgical complications