The majority of patients undergoing emergency laparotomy are older adults that carry the highest mortality. More research into the development of targeted interventions is required. Therefore, the aim of the study was to analyse the indications for emergency abdominal surgery in patients aged ≥ 65 admitted to the Department of General Surgery. The study included consecutive patients aged ≥ 65 who underwent emergency abdominal surgery within 48 h after admission at one institution. In 2010-2017, 986 patients were enrolled in the study (female 57%, male 43%). Patients were divided into three age groups, 65-70, 71-84 and ≥ 85, with 255 patients (25.9%), 562 patients (57.0%) and 169 patients (17.1%) in each group, respectively. In the first and second age groups, the most common indications for surgery were acute cholecystitis, non-malignant ileus, colorectal cancer complications and acute appendicitis. In the oldest patients, the most common indications were complications of colorectal cancer, acute cholecystitis, nonmalignant ileus and complications of diverticulosis. In the women, the biggest differences in indications between age groups were colorectal cancer (p = 0.025) and peptic ulcer disease complications (p = 0.005); in the men, the biggest difference was seen for complicated diverticulitis (p = 0.001). The most frequent comorbidities were heart diseases (81.0%), followed by endocrine (33.6%) and vascular diseases (22.7%). The three most common indications for emergency surgery in older patients at our institution were acute cholecystitis, colorectal cancer complications and non-malignant bowel obstruction, affecting 59.5% of this group of patients. Elective surgery and endoscopic screening have the potential to prevent major part of these acute diseases. However, further prospective research is necessary on this field, particularly among frail, older patients.
Medical history, physical examination and a Comprehensive Geriatric Assessment remain the most important elements in preparing an older patient for surgery, to determine the number of preoperative additional tests, and remain the strongest predictors of postoperative outcome. The additional 40-60 minutes devoted to its implementation at the time of qualification for surgery, is well worth the chance to significantly reduce the risk of complications in the postoperative period. The patient's chronological age alone is not a criterion for the type and number of additional tests. Routine biochemical blood serum tests (with the exceptions of haemoglobin, creatinine, albumin and HbA1c in diabetic patients) and other preoperative static investigations have not been shown to affect the risk of postoperative complications, no more so in the older population. It is also misleading to believe that a large number of preoperative tests will protect the attending physician from legal liability.
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