Emergency thoracic surgery in elderly patients

Abstract

ObjectivesEmergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients.DesignRetrospective chart review.SettingAcademic tertiary care referral center.ParticipantsEmergency patients treated at the Department of Thoracic Surgery, University Hospital of Luebeck, Germany.Main outcome measuresCo-morbidities, mortality, risk factors and hospital length of stay.ResultsA total of 124 thoracic procedures were performed on 114 patients. There were 79 men and 36 women (average age 72.5 ±6.4 years, range 65–94). The overall operative mortality was 25.4%. The most frequent indication was thoracic/mediastinal infection, followed by peri- or postoperative thoracic complications. Risk factors for hospital mortality were a high ASA score, pre-existing diabetes mellitus and renal insufficiency.ConclusionsOur study documents a perioperative mortality rate of 25% in patients over 65 who required emergency thoracic surgery. The main indication for a surgical intervention was sepsis with a thoracic/mediastinal focus. Co-morbidities and the resulting perioperative complications were found to have a significant effect on both inpatient length of stay and outcome. Long-term systemic co-morbidities such as diabetes mellitus are difficult to equalize with respect to certain organ dysfunctions and significantly increase mortality.

Effects of trauma scores on prognosis in chest traumas

“…Limmer ve ark. [24] kronik sistemik hastalığı olan ve acil ameliyat uygulanan hastalarda hastanede kalış süresinin uzadığını ve ameliyat sonrası mortalitenin arttığını bildirmişlerdir. Yazarlar ayrıca komorbiditenin prognoza etkisi değerlendirilir-ken; koroner arter hastalığı veya romatoid artritin, renal yetmezlik veya KOAH ile karşılaştırılamayacağını, fakat yine de sistemik hastalıkların tümünün mortalite ve morbidite artışına neden olduğunu bildirmişlerdir.…”

Renal Insufficiency Predicts Mortality in Geriatric Patients Undergoing Emergent General Surgery

“…15 In the vascular literature, severe chronic renal insufficiency has been associated with increased risks of death and diminished long-term survival after abdominal aortic aneurysm repair and lower extremity vascular reconstruction. [16][17][18][19][20] Rigdon et al found that patients with severe chronic renal insufficiency are at significantly greater risk than others for postoperative stroke and death after carotid endarterectomy, and they attributed these findings to difficulty controlling hypertension. 21 Sarac and associates also found that renal insufficiency was a predictor of 30-day mortality in patients with ruptured abdominal aortic aneurysms and a predictor of decreased long-term survival.…”