title: Never giving up: outcomes and presentation of emergency general surgery in geriatric octogenarian and nonagenarian patients.
abstract: BACKGROUND
  Aging of the population necessitates consideration of the increasing number of older adults requiring emergency care. The objective of this study was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery (EGS) patients with younger adults.
  
  
  METHODS
  Based on a standardized definition of EGS, patients in the 2007 to 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample were queried for primary EGS diagnoses. Included patients were categorized into older (≥80 years) vs younger (<80 years) adults based on a marked increase in mortality around aged 80 years. Using propensity scores, risk-adjusted differences in major morbidity, mortality, length of stay (LOS), and cost were compared.
  
  
  RESULTS
  Of 3,707,465 included patients, 17.2% (n = 637,588) were ≥80 years. Relative to younger adults, older patients most frequently presented for gastrointestinal-bleeding (odds ratio [95% confidence intervals]: 2.81 [2.79 to 2.82]) and gastrostomy care (2.46 [2.39 to 2.53]). Despite higher odds of mortality (1.67 [1.63 to 1.69]), older adults exhibited lower risk-adjusted odds of morbidity (.87 [.86 to .88]), shorter LOS (4.50 vs 5.14 days), and lower total hospital costs ($10,700 vs $12,500).
  
  
  CONCLUSIONS
  Octogenarian and/or nonagenarian patients present differently than younger adults. Reductions in complications, LOS, and cost among surviving older adults allude to a "survivorship tendency" to never give up, despite collectively higher mortality risk.
authors.affiliation: Division of General Surgery, Department of Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Adil A
authors.initials: AA
authors.lastname: Shah
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kodadek
authors.affiliation: Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.affiliation: Division of General Surgery, Department of Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Chapital
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
authors.forename: Aftab
authors.initials: A
authors.lastname: Iqbal
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Greene
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.affiliation: Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Havens
authors.affiliation: Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nitzschke
authors.affiliation: Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
authors.affiliation: Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Division of General Surgery, Department of Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA. Electronic address: ahhaider@partners.org.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004630:Emergencies; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D020379:Risk Adjustment; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States
keywords: Emergency general surgery; Geriatric; Nonagenarian; Octogenarian; Outcomes