In-Hospital and 6-Month Mortality Rates After Open Elective vs Open Emergent Colectomy in Patients Older Than 80 Years

Kurian, Ashwin A.; Suryadevara, Sree; Ramaraju, Divya; Gallagher, Sidhbh; Hofmann, Mary T.; Kim, Soo Jeong; Zebley, Mark; Fassler, Steven A.

doi:10.1007/dcr.0b013e3182060904

Cited by 31 publications

(21 citation statements)

References 16 publications

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“…Our study also confirmed that older age, emergency procedures and a high degree of comorbidity are associated with increased mortality after intestinal surgery 22 23 36 37. In addition, it is known from population-based studies that hospitalisation for ulcerative colitis has a two-peak age incidence in a number of countries including Denmark 38.…”

Section: Discussionsupporting

confidence: 83%

Thirty-day mortality after elective and emergency total colectomy in Danish patients with inflammatory bowel disease: a population-based nationwide cohort study

et al. 2012

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ObjectivesThe purpose of this investigation was to assess 30-day mortality among Danish inflammatory bowel diseases (IBD) patients and to examine the prognostic impact of hospital total colectomy volume, age, gender and comorbidity.DesignCohort study.SettingThe authors compared 30-day survival over the period 1996–2010 among 2889 IBD patients with total colectomy identified in the Danish National Registry of Patients. This registry covers all hospitals in Denmark. Postoperative survival patterns for patients with ulcerative colitis and Crohn's disease were compared, using proportional hazard regression. The regression model accounted for the timing of surgery, hospital total colectomy volume, age, gender and comorbidity.ParticipantsPatients were enrolled in the study if they had a hospital registry diagnosis of IBD, with accompanying procedure codes for total colectomy (see codes in online appendix table 1). Hospitalisations were described as elective or emergency, and patients were categorised as having Crohn's disease, ulcerative colitis or as a mixed group.Outcome measuresPrimary outcome measure was 30-day mortality.ResultsAmong 2889 IBD patients with total colectomy, 1439 (50%) underwent surgery during an emergency hospitalisation. Thirty-day mortality was 5.3% (76/1439) among emergency cases compared with 1% (14/1450) among elective cases. The highest mortality (8.1%; 11 of 136) was observed among Crohn's patients undergoing emergency surgery. The mortality of patients with ulcerative colitis undergoing emergency surgery was 5.2% (55/1056). After elective surgery, the 30-day mortality was 0.9% (8/938) among patients with ulcerative colitis and 1.5% (3/201) among Crohn's disease patients. Low hospital total colectomy volume, comorbidity and high age were associated with increased 30-day mortality in ulcerative colitis patients undergoing emergency surgery.ConclusionEmergency total colectomy among patients with ulcerative colitis and particularly Crohn's disease is associated with substantial 30-day mortality.

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Section: Discussionsupporting

confidence: 83%

Thirty-day mortality after elective and emergency total colectomy in Danish patients with inflammatory bowel disease: a population-based nationwide cohort study

et al. 2012

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“…Associations have been described between postoperative outcomes and perioperative variables in the older adult emergency surgery population, including complications and disease scoring systems (e.g., POSSUM). 7–10 However, risk factors in the entire adult emergency surgery population are less clear particularly for readmissions. Elucidating such risk factors may allow for earlier a modification of patient care or an enhancement of the discharge process to prevent unplanned readmissions.…”

mentioning

confidence: 99%

A composite index for predicting readmission following emergency general surgery

Muthuvel

Tevis

Liepert

et al. 2014

Journal of Trauma and Acute Care Surgery

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BACKGROUND Preventable readmission has become a national focus. It is clear that surgical patients present specific challenges to those interested in preventing readmission. Little is known about this outcome in the emergent population. We are interested in determining if there are readily available data variables to predict risk of readmission. The surgical Apgar score (SAS) is calculated from objective intraoperative variables and has been shown to be predictive of postoperative mortality in the nonemergent setting. The objectives of this study were to characterize 30-day readmissions in emergent general surgery and to determine whether certain variables were associated with readmissions. We hypothesized that the SAS correlates with the risk for readmission in emergency general surgery patients. PATIENTS AND METHODS Variables of interest were obtained from a retrospective analysis of the American College of Surgeons’ National Surgical Quality Improvement Program database at an academic institution, paired with the electronic medical record. We identified adult general surgery patients who underwent an emergency procedure from 2006 to 2012. Univariate analysis identified factors associated with 30-day readmission. Factors with p < 0.1 were included in the multivariate analysis to reveal potential risk factors. SPSS version 20 was used for the statistical analysis, with p < 0.05 considered to be significant on multivariate analysis. RESULTS As compared with nonemergency surgery patients, emergency surgery patients had a higher readmission rate (11.1% vs. 15.2%, p = 0.004). The SAS (odds ratio, 3.297; 95% confidence interval, 1.074–10.121; p = 0.037) and the combined variable of the American Society of Anesthesiologists Physical Status Classification and length of stay (odds ratio, 4.370; 95% confidence interval, 2.251–8.486; p < 0.001) were associated with elevated risk for readmission in emergency general surgery patients. CONCLUSION We have identified readily available measures that allow for the stratification of patients into low- and high-risk groups for 30-day readmission. The stratification of patients will enable the study of prospective interventions designed to decrease unplanned readmissions in emergency surgery patients. LEVEL OF EVIDENCE Prognostic study, level II.

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“…The elevated rates are likely related to an increasing number of synchronous comorbidities and lower performance status for this particular subset of the elderly. Moreover, patients discharged to institutions following surgery demonstrated 6-month mortality rates of 40 %, compared to 17 % of those who were discharged home [ 19 ]. Additionally, elderly patients with DNR orders undergoing emergent exploration also demonstrated higher mortality rates.…”

Section: Current Outcomes In the Geriatric Populationmentioning

confidence: 92%

“…Mortality rates are also higher in patients admitted from a long-term care facility or nursing home (47.6 %) [ 19 ]. The elevated rates are likely related to an increasing number of synchronous comorbidities and lower performance status for this particular subset of the elderly.…”

Section: Current Outcomes In the Geriatric Populationmentioning

confidence: 98%

Considerations for Geriatric Patients Undergoing Colorectal Surgery

Kasten

Francone

2016

The ASCRS Textbook of Colon and Rectal Surgery

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Key Concepts• The geriatric population is diverse, with varying levels of health status including physiologic reserve and cognitive function. As such, chronological age is a poor marker of functional, physical, and cognitive decline in the elderly.• Fit elderly patients, those without signifi cant comorbidities or cognitive decline, can be managed similar to that of younger patients. Frail patients are associated with higher morbidity and mortality in both elective and emergent operations.• Elderly patients undergoing emergent procedures are at high risk (17-31 %) for post-operative mortality.• Minimally invasive surgery is safe and appropriate in the elderly population, allowing them to benefi t from decreased post-operative morbidity, faster return of bowel function, decreased length of stay, and less pain.• While some assessment models identify age as an independent risk factor for adverse outcomes, a focus on chronologic age substantially limits effective management of the geriatric patient.• Frailty is used to represent a global limited reserve in the elder population. As such, abnormalities in frailty domains are a potentially useful tool for predicting poor outcomes.

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In-Hospital and 6-Month Mortality Rates After Open Elective vs Open Emergent Colectomy in Patients Older Than 80 Years

Cited by 31 publications

References 16 publications

Thirty-day mortality after elective and emergency total colectomy in Danish patients with inflammatory bowel disease: a population-based nationwide cohort study

Thirty-day mortality after elective and emergency total colectomy in Danish patients with inflammatory bowel disease: a population-based nationwide cohort study

A composite index for predicting readmission following emergency general surgery

Considerations for Geriatric Patients Undergoing Colorectal Surgery

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