AUTHOR=Tay Hui Sian , Wood Adrian D. , Carter Ben , Pearce Lyndsay , McCarthy Kathryn , Stechman Michael J. , Myint Phyo K. , Hewitt Jonathan
TITLE=Impact of Surgery on Older Patients Hospitalized With an Acute Abdomen: Findings From the Older Persons Surgical Outcome Collaborative
JOURNAL=Frontiers in Surgery
VOLUME=7
YEAR=2020
URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2020.583653
DOI=10.3389/fsurg.2020.583653
ISSN=2296-875X
ABSTRACT=Background: The impact of surgery compared to non-surgical management of older general surgical patients is not well researched.
Methods: We examined the association between management and adverse outcomes in a cohort of emergency general surgery patients aged > 65 years. This multi-center study included 727 patients (mean+/-SD, 77.1 ± 8.2 years, 54% female) admitted to five UK hospitals. Data were analyzed using multi-level crude and multivariable logistic regression. Outcomes were: mortality at Day 30 and 90, length of stay, and readmission within 30 days of discharge. Covariates assessed were management approach, age, sex, frailty, polypharmacy, anemia, and hypoalbuminemia.
Results: Approximately 25% of participants (n = 185) underwent emergency surgery. Frailty and albumin were associated with mortality at 30 (frailty OR = 3.52 [95% CI 1.66–7.49], albumin OR = 3.78 ([95% CI 1.53–9.31]), and 90 days post discharge (frailty OR = 3.20 [95% CI 1.86–5.51], albumin OR=3.25 [95% CI 1.70–6.19]) and readmission (frailty OR = 1.56 [95% CI (1.04–2.35)]). Surgically managed patients and frailty had increased odds of prolonged hospitalization (surgery OR = 5.69 [95% CI 3.67–8.80], frailty OR = 2.17 [95% CI 1.46–3.23]).
Conclusion: We found the impact of surgery on length of hospitalization in older surgical patients is substantial. Whether early comprehensive geriatric assessment and post-op rehabilitation would improve this outcome require further evaluation.