title: A 15-year retrospective analysis of the epidemiology and outcomes for elderly emergency general surgical admissions in the North East of England: A case for multidisciplinary geriatric input.
abstract: BACKGROUND
  Life expectancies in the UK are increasing and with this there is an increasing elderly population with more complex co-morbidity. Emergency surgery in the elderly is challenging in terms of decision making, managing co-morbidity and post-operative rehabilitation with high morbidity and mortality. To optimise service design and development, it is important to understand the changing pattern of emergency surgical care for this group.
  
  
  METHODS
  After obtaining necessary approvals, we approached each hospital trust in the North of England for details of every emergency admission under a general surgeon from 2000 to 2014. Data for each admission included demographics, co-morbidities, diagnoses, procedures undertaken and outcomes.
  
  
  RESULTS
  There were 105 002 elderly (≥70 years) emergency general surgical admissions, and mean age and co-morbidity (defined by Charlson index scores) increased (both p < 0.001). Operative intervention was undertaken in a similar proportion of patients in all age groups (13%), with more patients undergoing operations over time (p < 0.001), of which 50% were within 48 h of admission. Overall in-hospital mortality decreased significantly as did length of hospital stay (both p < 0.001). Factors associated with increased 30 day in-hospital mortality were increasing age and Charlson score, admissions directly from clinic, operations undertaken at the weekend and patients admitted earlier in the study period.
  
  
  CONCLUSIONS
  The workload of emergency general surgery in the elderly is becoming more complex. This challenge is already being addressed with improvements in outcomes. The data presented here reinforces the need for new models of care with increased multidisciplinary geriatric care input into elderly surgical patient care in the perioperative period.
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK.
authors.forename: Ross C
authors.initials: RC
authors.lastname: McLean
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK.
authors.forename: Iain J D
authors.initials: IJ
authors.lastname: McCallum
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Dixon
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK. Electronic address: paul.o'loughlin@ghnt.nhs.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: O'Loughlin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004638:Emergency Treatment; D004739:England / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data
keywords: Elderly; Emergency; General surgery; Mortality; Outcomes