Emergency general surgery in the geriatric patient

Abstract

Background: Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care.Methods: This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. Results:The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care.Conclusion: Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.

Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference

“…While age alone is not decisive for outcome, it should be recognized that elderly patients are at high risk for adverse outcomes, including death [39]. Core to the associated poor outcomes is the reduced physiological reserve and limited response to any minor or major stressor that comes with age [40] and which is summarized in the concept of “frailty” [41].…”

Attitudes of Surgeons toward Elderly Cancer Patients: A Survey from the SIOG Surgical Task Force

“…Communication in these cases is essential with the patients, who should be able to make their own decisions and designate their goals of care, if able, but also with their family and caretakers [25]. Patients' perspectives are essential in establishing a proper understanding of the QoL goals.…”

Emergency surgery in octogenarians: Outcomes and factors affecting mortality in the general hospital setting

“…Predicting mortality in the older population can be difficult . Although age is a predictor of mortality, the presence of comorbid conditions is likely a stronger predictor of poor outcomes .…”

“…In most developed nations, populations are aging, with people enjoying better health for longer . This brings challenges in the context of emergency surgery . Expectations of treatment and outcomes are increasing for patients and their relatives, while patients who are older and have more comorbidities are presenting as surgical emergencies.…”