doiSerbia

Estimation of risk factors of early postoperative mortality in elderly patients who are subjected to emergency operations of the gastrointestinal tract

Pešić Ivan (University of Niš, Faculty of Medicine, Niš Clinical Center, Clinic for Digestive Surgery, Niš, Serbia)
Radojković Milan (University of Niš, Faculty of Medicine, Niš Clinical Center, Clinic for Digestive Surgery, Niš, Serbia)
Nestorović Milica (University of Niš, Faculty of Medicine, Niš Clinical Center, Clinic for Digestive Surgery, Niš, Serbia)
Pecić Vanja (University of Niš, Faculty of Medicine, Niš Clinical Center, Clinic for Digestive Surgery, Niš, Serbia)

Introduction/Objective. The elderly (age ≥ 65 years) comprise an increasing proportion of patients undergoing emergency general surgery (EGS) procedures nowadays. The objective of the paper was to determine the intra-hospital mortality rate in elderly patients undergoing emergency gastrointestinal surgical procedures. Methods. 914 elderly patients (> 65 years old) were examined, divided into two groups: emergency and elective surgery patients, treated for diseases (benign and malignant) of the stomach, duodenum, small intestine and colon. The patients were divided into four age groups and five American Society of Anesthesiologists (ASA) groups, taking into account the presence of chronic diseases, the values of some laboratory parameters, administering transfusion, and the occurrence of surgical complications during hospitalization. Results. The mortality rate among elderly patients was 17.8%. The univariate analysis in EGS patients revealed that gastro-duodenal surgical interventions (p < 0.001), ASA ≥ 3 score (p < 0.001), heart, lung, kidney diseases, and postoperative complications (p < 0.001), as well as the white cell count > 10,000/mm3 (p = 0.043) were independent risk factors for mortality. In the multivariate analysis, in EGS patients, the significant risk factors for mortality were gastric surgical interventions (p = 0.001), ASA score of 4 (p < 0.001), heart and kidney disease (p ≤ 0.001), and white cell count > 10,000/mm3 (p = 0.039). Conclusion. The characterization of independent validated risk indicators for mortality in those patients is essential and may lead to an efficient specific workup, which constitutes a necessary step towards developing a dedicated score for elderly patients.

Keywords: elderly, gastrointestinal surgery, mortality