Octogenarian Abdominal Surgical Emergencies: Not So Grim a Problem With the Acute Care Surgery Model?

Rubinfeld, Ilan; Thomas, Casey; Berry, Stepheny; Murthy, Raghav; Obeid, Nadia; Azuh, Oguchukwu; Jordan, John R.; Patton, Joe H.

doi:10.1097/ta.0b013e3181ad6690

Cited by 36 publications

(23 citation statements)

References 15 publications

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“…From different studies, focusing on outcome after abdominal surgery in the elderly, we know that the hospital mortality can be as high as 15% to 26%. 12,13 Although age and most age-related comorbidities, such as renal dysfunction and cardiopulmonary disease, are repeatedly mentioned as negative predictive factors for survival, the outcome seems far less dismal than reported and suggested in the literature. 14,15 Even though the survival rates for octogenarians are less favorable compared with a younger group, a mean of 3.3 more life-years (median, 2.4 years) can be gained with a relatively low morbidity.…”

Section: Discussionmentioning

confidence: 72%

Effectiveness of treatment for octogenarians with acute abdominal aortic aneurysm

Scheer

Pol

Haveman

et al. 2011

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 72%

Effectiveness of treatment for octogenarians with acute abdominal aortic aneurysm

Scheer

Pol

Haveman

et al. 2011

Journal of Vascular Surgery

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“…Reports also indicate that up to 70% of EGS patients require an operation, 38 but only half of these operations are performed at night. 11,12,39 Although many of our respondents reported no EGS block time for semi-urgent EGS cases, those with a fully or partially implemented ACS model were far more likely to have any designated block time. For patients who do not need immediate surgery, accessible ORs during regular hospital hours presumably reduces wait times for semi-urgent procedures.…”

Section: Discussionmentioning

confidence: 82%

Variations in the implementation of acute care surgery

Santry¹,

Madore²,

Collins³

et al. 2015

Journal of Trauma and Acute Care Surgery

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BACKGROUND To date, no studies have reported nationwide adoption of Acute Care Surgery (ACS) or identified structural and/or process variations for the care of emergency general surgery (EGS) patients within such models. METHODS We surveyed surgeons responsible for EGS coverage at University HealthSystems Consortium hospitals using an 8-page postal/email questionnaire querying respondents on hospital and EGS structure/process measures. Survey responses were analyzed using descriptive statistics, univariate comparisons, and multivariable regression models. RESULTS 258 of 319 (81%) potential respondents completed surveys. 81 hospitals (31%) had implemented ACS while 134 (52%) had a traditional general surgeon on-call model (GSOC). 38 (15%) hospitals had another model (HYBRID). Larger bed, university-based, teaching hospitals with Level 1 trauma center verification status located in urban areas were more likely to have adopted ACS. In multivariable modeling, hospital type, setting, and trauma center verification predicted ACS implementation. EGS processes of care varied with 28% GSOC having block time vs 67% ACS (p<0.0001); 45% GSOC providing ICU care to EGS patients in a surgical/trauma ICU vs 93% ACS (p<0.0001); GSOC sharing call among 5.7 (+/− 3.2) surgeons vs 7.9 (+/−2.3) ACS surgeons (p<0.0001); and 13% GSOC taking in-house EGS call vs 75% ACS (p<0.0001). Among ACS hospitals there were variations in patient cohorting (25% EGS patients alone; 21% EGS+trauma; 17% EGS+elective; 30% EGS+trauma+elective), data collection (26% had prospective EGS registries), and patient handoffs (56% had attending surgeon presence), call responsibilities (averaging 4.8 (+/− 1.3) calls per month with 60% providing extra call stipend and 40% with no post-call clinical duties). CONCLUSION The potential of the ACS on the national crisis in access to EGS care is not fully met. Variations in EGS processes of care among adopters of ACS suggest that standardized criteria for ACS implementation, much like trauma center verification criteria, may be beneficial. LEVEL OF EVIDENCE Survey results, Level III

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“…16 The acute care surgery model highlights the challenges in taking care of acutely ill patients with a high level of acuity and illness, but others have demonstrated good outcomes with elderly patients undergoing emergency abdominal surgery. 17 Many patients present with previously untreated disease processes and with poor preventive medicine history. 17 The rapid increase in the elderly population has led to an increased awareness of the differences in presentation and outcomes for many acute surgical illnesses in this special population.…”

Section: Introductionmentioning

confidence: 99%

Geriatric small bowel obstruction: an analysis of treatment and outcomes compared with a younger cohort

Krause

Webb

2015

The American Journal of Surgery

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Background Small bowel obstruction (SBO) is a common condition, but little is known about its presentation, management, and outcomes in geriatric patients. Methods A retrospective review was performed comparing geriatric (≥65 years of age) and non-geriatric patients admitted with SBO. Admission characteristics, treatment, and outcomes were compared. Data analysis included Student’s t test and chi-square test or Fisher exact test. Results Among 80 geriatric and 136 non-geriatric patients no difference was observed between admission characteristics, treatment, time to or type of surgery, length of post-op stay, or overall complications. Cardiac complications (15% vs 0%, p=0.0082) and sub-acute care facility discharge (29% vs 5%, p<0.001) were more common for geriatric patients. Conclusions Compared to younger adults, elderly patients with SBO have similar presentations and overall outcomes with the exception of cardiac morbidity and discharge disposition. Pre-operative attention to cardiac risk profile and discharge disposition discussion should be encouraged. Summary This study analyzes geriatric patients presenting with small bowel obstruction when cared for by an Acute Care Surgery service. Compared to younger adults, the presentation, treatment response, and outcomes are similar with the exception of cardiac complications and discharge destination.

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Octogenarian Abdominal Surgical Emergencies: Not So Grim a Problem With the Acute Care Surgery Model?

Cited by 36 publications

References 15 publications

Effectiveness of treatment for octogenarians with acute abdominal aortic aneurysm

Effectiveness of treatment for octogenarians with acute abdominal aortic aneurysm

Variations in the implementation of acute care surgery

Geriatric small bowel obstruction: an analysis of treatment and outcomes compared with a younger cohort

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