Episode 478

Journal Review in Emergency General Surgery: EGS in Patients > 65

EP. 478 •

Mar 31

• 27 MIN

Journal Review in Emergency General Surgery: EGS in Patients > 65

OVERVIEW

Join our Emergency General Surgery Team as they discuss EGS in patients > 65. 

Introduction

– > 65 = 40% of EGS admissions 
– In-hospital mortality for EGS in older adults is approximately 7-12% and the one-year mortality is around 30-38%.
– High risk due to decreased reserve, poor nutritional status, and chronic medical conditions 
– Frailty correlates with poor post-operative outcomes

Paper #1: Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, Haut ER, Efron DT, Sakran JV. Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg. 2018 Jun;84(6):864-875. 

– retrospective population-based cross-sectional study using administrative data. 
– looks at the association between surgeon and hospital annual experience with outcomes in geriatric patients with EGS conditions.
– Note Table 2 provides outcomes broken down by type of surgery
– Key finding: patients operated on by a low-volume surgeon had about twice the odds of mortality, and 1.7X the odds of failure to rescue

Paper #2: Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. Alive and at home: Five-year outcomes in older adults following emergency general surgery. J Trauma Acute Care Surg. 2021 Feb 1;90(2):287-295. 

– large-scale population-based retrospective cohort study looking at long-term outcomes of older adults with admissions for emergency general surgery diagnoses
– primary outcome of interest is “aging in place” or being able to reside in one’s home for as long as possible. 
– Key finding: being admitted for an EGS diagnosis reduces your survival and time in your home by about 7 months.
– Very little reduction in low-risk diagnoses (acute appendicitis/cholecystitis)
– 57% of patients were alive and in their home 5 years later

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