Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

Rix, Thomas; Bates, Tom

doi:10.1186/1749-7922-2-16

Cited by 83 publications

(80 citation statements)

References 43 publications

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“…The ability of health care providers to predict death before surgery is inadequate. 38,39 Decisions to withhold care at the time of presentation may be appropriate for only a small proportion of older adults with advanced frailty or severe comorbidities. Research is needed to develop strategies, such as time-limited trials of care, 40 to minimize the occurrence of high-cost inpatient deaths.…”

Section: Discussionmentioning

confidence: 99%

The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

Bailey

Davis

Levy

et al. 2016

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Background: Postoperative complications have been identified as an important and potentially preventable cause of increased hospital costs. While older adults are at increased risk of experiencing complications and other adverse events, very little research has specifically examined how these events impact inpatient costs. We sought to examine the association between postoperative complications, hospital mortality and loss of independence and direct inpatient health care costs in patients 70 years or older who underwent nonelective abdominal surgery. Methods:We prospectively enrolled consecutive patients 70 years or older who underwent nonelective abdominal surgery between July 1, 2011, and Sept. 30, 2012. Detailed patient-level data were collected regarding demographics, diagnosis, treatment and outcomes. Patient-level resource tracking was used to calculate direct hospital costs (2012 $CDN). We examined the association between complications, hospital mortality and loss of independence cost using multiple linear regression.Results: During the study period 212 patients underwent surgery. Overall, 51.9% of patients experienced a nonfatal complication (32.5% minor and 19.4% major), 6.6% died in hospital and 22.6% experienced a loss of independence. On multivariate analysis nonfatal complications (p < 0.001), hospital mortality (p = 0.021) and loss of independence at discharge (p < 0.001) were independently associated with health care costs. These adverse events respectively accounted for 30%, 4% and 10% of the total costs of hospital care. Conclusion:Adverse events were common after abdominal surgery in older adults and accounted for 44% of overall costs. This represents a substantial opportunity for better patient outcomes and cost savings with quality improvement strategies tailored to the needs of this high-risk surgical population.Contexte : Les complications postopératoires sont une cause évitable qui contribue grandement aux coûts hospitaliers élevés. Malgré le fait que les personnes âgées courent un risque accru de subir des complications ou des événements indésirables, peu de recherches ont étudié l'incidence de ces éléments sur les coûts d'hospitalisation. Nous nous sommes penchés sur la relation entre les coûts des soins de santé assumés par les malades hospitalisés et les complications postopératoires, la mortalité hospitalière et la perte d'autonomie auprès d'une population de patients de 70 ans et plus ayant subi une intervention chirurgicale abdominale non facultative.Méthodes : La cohorte prospective a été formée de patients consécutifs âgés de 70 ans et plus ayant subi une intervention chirurgicale abdominale non facultative entre le 1 er juillet 2011 et le 30 septembre 2012. Des données détaillées concernant leur profil démographique, leur diagnostic, leur traitement et leurs résultats ont été recueillies. Le calcul des coûts hospitaliers directs est basé sur un suivi des ressources utilisées par les patients (en dollars canadiens, 2012). Au moyen d'une régression linéaire multiple, nous avons an...

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Section: Discussionmentioning

confidence: 99%

The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

Bailey

Davis

Levy

et al. 2016

cjs

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“…Several risk scores for prediction of outcome of peptic ulcer patients have been developed. [13][14][15][16][17][18][19] APACHE score (Acute Physiologic And Chronic Health Evaluation, SAPS (Simplified Acute Physiology Score), MOF Score (Multi Organ Failure) MPI score (Mannheim Peritonitis Score) and other scoring system are cumbersome in difficult to use in all emergency setup and many of them incorporate the intra operative and post-operative status as well.…”

Section: Introductionmentioning

confidence: 99%

Improving outcome in perforated peptic ulcer emergency surgery by Boey scoring

2016

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“…3,4 Seniors are a unique subset of patients with their own problems and vulnerabilities including the cumulative loss of physiologic reserve in almost every organ system, 5 otherwise known as frailty. Recent studies involving patients older than 80 years demonstrated that age and number of comorbidities did not accurately predict poor surgical outcomes, 6 and further studies have suggested that frailty measures are better overall predictors.…”

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confidence: 99%

Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis

et al. 2015

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Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis Background: Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery. Methods:We conducted a retrospective cohort study of patients aged 65-80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home.Results: Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) Conclusion: American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home.Contexte : La population qui connaît la croissance la plus rapide est celle des adultes âgés (≥ 65 ans). Ces personnes nécessitent un nombre croissant d'interventions chirurgicales urgentes. Or, la chirurgie d'urgence comporte souvent un risque de décès pour les patients âgés. Notre objectif était d'identifier les prédicteurs de la mortalité et d'une issue négative chez les patients âgés soumis à une chirurgie générale d'urgence.Méthodes : Nous avons procédé à une étude de cohorte rétrospective chez des patients de 65 à 80 ans soumis à une chirurgie générale d'urgence entre 2009 et 2010 dans un centre de soins tertiaires. Nous avons recueilli les données démographiques, les comorbidités, les complications perhospitalières, la mortalité et les détails sur l'état général de santé des patients. Nous avons utilisé l'analyse de régression logistique afin de dégager les prédicteurs ajustés en fonction des covariables pour la mortalité perhospitalière et les congés hospitaliers des patients vers leur domicile.Résultats : Notre analyse a regroupé 257 patients âgés en moyenne de 72 ans; 52 % étaient des hommes. La mortalité perhospitalière a été de 12 %. La mortalité a été associée à des patients qui se classaient dans une catégorie ASA (American Society of Anesthesiologists) plus élevée (rapport des cotes [RC]

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Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

Abstract: Background: The decision on whether to operate on a sick elderly person with an intraabdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation.

Cited by 83 publications

References 43 publications

The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

Improving outcome in perforated peptic ulcer emergency surgery by Boey scoring

Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis

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