American Journal of Surgery · Aug 15, 2024

The impact of comorbidities and functional status on outcomes in the older adult emergency general surgery patient

By Panossian VS, Proano J, Abiad M et al.

BACKGROUND: The aim of this study is to quantify the relative contribution of comorbidities and pre-operative functional status on outcomes in geriatric emergency general surgery (EGS) patients. METHODS: This is a retrospective study of older-adult EGS patients at an academic medical center between 2017 and 2018. Patients ≥65 years were included. The primary outcomes examined were 30-day mortality, 30-day morbidity, and length of stay (LOS). RESULTS: 734 patients were included. The mean age was 76, and 48.9 % received non-operative management. The median LOS was 6.8 days; 11.8 % of patients died within 30 days, and 40.6 % developed morbidities. Lacking capacity to consent on admission was independently associated with 30-day mortality (OR: 2.63, [1.32-5.25], p = 0.006). Comorbidities associated with developing morbidity were CVA with neurologic deficit (OR: 2.29, [1.20-4.36], p = 0.012), CHF (OR: 2.60, [1.64-4.11], p < 0.001), in addition to pre-operative delirium (OR: 3.42, [1.43-8.14], p = 0.006). CONCLUSIONS: A significant contribution to outcomes is determined by pre-admission comorbidities and cognitive and functional status. Opportunities exist for collaboration between Acute Care Surgery and geriatric medicine teams for the optimization of comorbidities.

doi.org/10.1016/j.amjsurg.2024.115903 PubMed 39178600 Populations