Association of Comorbidities and Functional Level With Mortality in Geriatric Bowel Perforation.

ABSTRACT

INTRODUCTION: Spontaneous bowel perforation is associated with high morbidity and mortality. This entity remains understudied in the geriatric patient. We sought to use a national surgical sample to uncover independent predictors of mortality in elderly patients undergoing emergent operation for perforated bowel. METHODS: Using the American College of Surgeons National Surgical Quality Improvement database, years 2007 to 2017, all geriatric patients (age ≥65 y) who underwent emergency surgery and who had a postoperative diagnosis of bowel perforation were included. Univariate and multivariable analyses were used to identify independent predictors of 30-d mortality. RESULTS: A total of 8981 patients were included. The median (interquartile range) age was 75 y (69, 82), and 59.0% were female. Twenty-one percent of patients were partially or totally dependent, and 25.2% were admitted from sources other than home. Overall, 30-d mortality rate was 22.1%. Independent predictors of mortality included the following age 70-79 y (odds ratio [OR] 1.59, P < 0.001), age ≥80 y (OR 3.23, P < 0.001), American Society of Anesthesiologists ≥3 (OR 4.74, P < 0.001), admission from chronic care facility (OR 1.61, P < 0.001), being partially or totally dependent (OR 1.50, P < 0.001), chronic steroid use (OR 1.36, P < 0.001), and preoperative septic shock (OR 3.74, P < 0.001). Having immediate fascial closure was protective against mortality (immediate fascial closure only, OR 0.55, P < 0.001; -immediate closure of all surgical site layers, OR 0.44, P < 0.001). CONCLUSIONS: In geriatric patients, functional status and chronic steroid therapy play an important role in determining survival following surgery for bowel perforation. These factors should be considered during preoperative counseling and decision-making.