Immediate postoperative and mid-term survival in nonagenarians undergoing non-traumatic emergency surgery.

BACKGROUND: Nonagenarian people are increasingly using the emergency services, however, few studies have addressed this population. The goal of this prospective observational study is to determine relevant factors that independently reduce their immediate postoperative and mid-term survival. METHODS: We included all the nonagenarians who underwent non-traumatic emergency surgery between 2006-2011. The dependent variable, days of postoperative survival, was studied at 2 intervals: 0-30 days and 31 days to 1 year after surgery (immediate and mid-term respectively). Firstly, we calculated the Kaplan-Meier survival curve (KMsc) of the whole population. To analyse the bivariate relationship between each of the pre-, intra-, and postoperative variables and mortality we used c2 and Fischer's test. Finally, we performed a stepwise Cox regression analysis and developed two models -one for each interval. RESULTS: The study included 142 patients. The overall one-year mortality rate was 47.2%, and the 30-day mortality rate was 35.9%. The KMsc showed a steep drop during the first month, and then a more gradual one for the rest of year. The inflection point was at day 26. The variables associated with a reduced immediate postoperative survival were neoplasms and 4 complications: heart failure, pulmonary aspiration, renal impairment and stroke. The factors associated with a reduced mid-term survival were: postoperative arrhythmia, surgical reintervention, and perioperative red blood cell transfusion. CONCLUSION: Postoperative complications are an important predictor of reduced survival both immediately, and in the mid-term. Furthermore, most postoperative mortality occurs within the first 26 days postsurgery; hence the need for an aggressive treatment of such complications during this period.

Anaemia and transfusion in nonagenarians undergoing emergency, non-traumatic surgery: a prospective observational study.

OBJECTIVES: To characterise transfusion and determine its main predictors in nonagenarians undergoing non-elective, non-traumatic surgery. Simultaneously, we compared nonagenarians to a similar, but younger sample, as far as the transfusional policy is concerned. BACKGROUND: Perioperative anaemia and transfusion are currently topical, but little is known about them in this population. METHODS: In this prospective observational study, we recruited 135 patients older than 90 who underwent a non-elective, non-traumatic procedure, between 2006 and 2011. A descriptive statistical analysis was performed and a logistic regression model developed. As a control sample, we used a similar number of patients in their third age (between 65 and 85 years old), who underwent the same procedure, during the same period. RESULTS: Thirty-five per cent of the nonagenarians were transfused. The main independent factors associated with transfusion were anaemia (OR 6·77, P < 0·01), a coexisting neoplasm (OR 10·99, P < 0·01) and the need for an exploratory laparotomy (OR 3·05, P = 0·01). When comparing the nonagenarians to the younger group, we found a significant difference in their basal health status and the mortality rate (P < 0·01), but the transfusion policy did not differ substantially, except for the haemoglobin threshold (P = 0·01). CONCLUSIONS: The independent transfusion predictors in nonagenarians should be taken into account for cross-matching. Transfusional policy being similar between nonagenarians and third-aged patients; the differences in thresholds were due to the differences in the populations.

Observational study of nonogenarians undergoing emergency, non-trauma surgery.

BACKGROUND: Nonagenarian population is growing, and so is the number of them needing emergency surgery. Yet, their treatment is often based on the outcomes of younger patients: although old age is known to be a risk factor for surgery, its level is not clear. This is a prospective, observational study to describe the population. It is aimed at providing quantified scientific evidence of the current procedures and their outcomes. METHODS: All non-traumatic nonagenarians who underwent surgery between July 2006 and September 2010 in our University Hospital were recruited and followed up over a month after discharge. A descriptive statistical analysis was performed. RESULTS: Of the approximately 12 660 surgical emergencies, 102 were nonagenarians: 69.6% were women, who mostly had an ASA score III (62.7%). Perioperative morbidity and mortality rates of 61.6% [95% confidence interval (CI): 52.33-71.19%] and 35.3% (95% CI: 26.01-44.57%), respectively, were found statistically associated with preoperative neoplasms. The most frequent causes of surgery were acute limb arterial thrombosis (20), incarcerated hernia (17), and bowel occlusion (14). Confusion, renal failure, and abdominal problems accounted for the most frequent causes of morbidity. Among them, abdominal complications, cardiogenic pulmonary oedema, aspiration, stroke, and renal failure were associated with mortality. CONCLUSIONS: The study gave scientific support and actual figures to many intuitive beliefs: morbidity and mortality are high and are associated with many preoperative comorbidities. All this, combined with an already reduced life expectancy, and a presumably low physiological reserve makes these patients particularly vulnerable to emergency surgery.