Outcomes of emergency laparoscopy in the elderly

Abstract

Introduction This paper assessed the association between operative approach and postoperative in-hospital mortality in elderly patients undergoing emergency abdominal surgery. Patients undergoing emergency laparotomy have high morbidity and mortality rates. One-third of patients requiring emergency surgery are over 75 years old, and their in-hospital mortality rate exceeds 17%. Fewer than 20% of emergency abdominal operations in the UK are attempted laparoscopically, and only 10% are completed laparoscopically. Little is known about how laparoscopic emergency surgery in the elderly might affect outcomes. Methods An observational UK study was performed using the prospectively maintained National Emergency Laparotomy Audit (NELA) database. Operative approach, NELA risk-prediction score and in-hospital mortality were recorded. The effect of operative approach on in-hospital mortality was analysed, both on a national basis and in a high-volume laparoscopic centre. Results A total of 47,667 patients were included in the study, of whom 15,068 were over 75 years of age. Nationally, surgery was completed by the laparoscopic approach in 7.8% of patients aged over 75; both crude mortality (9.2%) and risk-adjusted mortality (7.1%) were significantly reduced (p<0.0001). In our unit, surgery was completed laparoscopically in 48.4% of patients aged over 75; both crude mortality (6.6%) and risk-adjusted mortality (3.3%) were significantly reduced (p<0.0001). Conclusion Laparoscopy in emergency surgery has been shown in this study to significantly reduce in-hospital mortality in elderly patients and should be embraced in every centre dealing with emergency abdominal surgery.

Laparoscopy for emergency abdominal surgery is associated with reduced physical functional decline in older patients: a cohort study

“…Several tools exist to identify frailty in emergency cases, and in a simplified approach, previously, we revealed that low psoas muscle volume predicted early postoperative functional decline [ 32 ]. In addition, recent studies have shown that the use of laparoscopy in emergency abdominal surgery demonstrates a significant reduction in mortality in frail older patients [ 33 ]. This study found that LS, compared to OS, was less likely to be statistically associated with a postoperative functional decline in older individuals.…”

Comparison of major abdominal emergency surgery outcomes across organizational models of emergency surgical care: Analysis of the UK NELA national database

“…An EGS care model is but one of many innovations, which is changing the paradigm of emergency surgical care. There is significant evidence pointing toward other modifiable factors such as laparoscopy, 14,16 particularly in the elderly, 32 that can result in improved outcomes in this high-risk cohort of emergency patients. Evidence from the United States points toward improved outcomes in hospitals that have dedicated acute surgery units, with important factors cited such as improved access to emergency theaters and interventional services such as radiology 6,7,10,30 .…”