Operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients


Soyalp C., Yüzkat N., Kılıç M., Akyol M. E. , Demir C. Y. , Gulhas N.

AGING CLINICAL AND EXPERIMENTAL RESEARCH, vol.31, no.3, pp.403-410, 2019 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 31 Issue: 3
  • Publication Date: 2019
  • Doi Number: 10.1007/s40520-018-0976-z
  • Journal Name: AGING CLINICAL AND EXPERIMENTAL RESEARCH
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.403-410
  • Keywords: Elderly, Surgery, Emergency, Elective, Anesthesia, Co-morbidity, ASA class, Mortality, COMPREHENSIVE GERIATRIC ASSESSMENT, GENERAL-ANESTHESIA, AGING POPULATION, RISK-FACTORS, OUTCOMES, MORBIDITY, MORTALITY
  • Van Yüzüncü Yıl University Affiliated: Yes

Abstract

AimTo evaluate operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients.MethodsA total of 533 geriatric patients (aged65 years, median age: 73.0 years, 50.7% were females) who underwent either elective surgery (n=285) or emergency surgery (n=248) were included in this study. Data on patient demographics, co-morbid disorders, type of surgery and anesthesia, American Society of Anesthesiologists (ASA) physical status (PS) classification, length of hospital stay, length of ICU stay, hospitalization outcome, prognosis (survivor, non-survivor) were obtained from medical records.ResultsEmergency surgery group was associated with higher prevalence of ASA-PS III (48.8 vs. 25.6%, p<0.001) and ASA-PS IV (19.0 vs. 0.4%, p<0.001) categories and higher mortality rates (20.6 vs. 4.9% vs. p<0.001) when compared to the elective surgery group. ASA-PS IV category was associated with oldest patient age (median 82.0 vs. 71.0years for ASA-PS I and II, p<0.001 for each and versus 75.0years for ASA-PS III, p<0.05) and highest mortality rate (35.4 vs. 3.4% for ASA-PS I, 6.0% for ASA-PS II and 16.5% for ASA-PS III, p<0.001) as compared with other categories.ConclusionIn conclusion, our findings in a retrospective cohort of elderly surgical patients revealed high prevalence of co-morbidities, predominance of ASA-PS II or ASA-PS III classes and an overall in-hospital mortality rate of 12.2%. Emergency as compared with elective surgery seems to be associated with older age, male gender, ASA-PS III and IV classes, higher likelihood of postoperative ICU transfer and higher mortality rates.