Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World Journal of Gastrointestinal Surgery. Sep 27, 2015; 7(9): 208-213
Published online Sep 27, 2015. doi: 10.4240/wjgs.v7.i9.208
Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: A single center experience
Marc Ong, Tan Yu Guang, Tan Kok Yang
Marc Ong, Tan Yu Guang, Tan Kok Yang, Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
Author contributions: Ong M designed the study, collected data and wrote the paper; Guang TY collected the data and helped write the paper; Yang TK helped design the study, analyzed the data and helped edit the paper for final submission.
Institutional review board statement: The study was reviewed and approved by the Khoo Teck Puat Hospital Institutional Review Board.
Informed consent statement: Consent was not obtained in view of retrospective nature of study but the presented data are anonymized and risk of identification is low.
Conflict-of-interest statement: There were no conflicts of interest to disclose among the authors.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at tan.kok.yang@alexandrahealth.com.sg.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tan Kok Yang, MBBS, MRCS, FRCS, FAMS, Head and Senior Consultant, Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore. tan.kok.yang@alexandrahealth.com.sg
Telephone: +65-66022207 Fax: +65-66023777
Received: April 22, 2015
Peer-review started: April 23, 2015
First decision: June 9, 2015
Revised: June 24, 2015
Accepted: August 4, 2015
Article in press: August 7, 2015
Published online: September 27, 2015
Abstract

AIM: To determine predisposing factors leading to surgical delay in elderly patients with acute abdominal conditions and its impact on surgical outcomes.

METHODS: A retrospective review of a total of 144 patients aged 60 years and older who had undergone emergency abdominal surgery between 2010 and 2013 at a regional general hospital was analysed. The operations analysed were limited to perforated or gangrenous viscus and strangulated hernia. Patient demographic features, time taken to obtain a computed tomography scan, time taken to surgery and the impact on postoperative morbidity and mortality were analysed.

RESULTS: The mean age was 70.5 ± 9.1 years and median time taken to surgery was 9 h. The overall mortality and complication rates (Clavien Dindo 3 and above) were 9% and 13.1% respectively. Diabetes mellitus was a significant predisposing factor which had an impact on surgical delays. Delays in surgery more than 24 h led to higher complication rates at 38.9% (P = 0.003), with multivariate analysis confirming it as an independent factor. Delays in obtaining a computed tomography (CT) scan was also shown to result in higher complication rates (Clavien Dindo 3 and above).

CONCLUSION: Delays in performing emergency surgery in elderly lead to higher complication rates. Obtaining CT scans early also may facilitate prompt diagnosis of certain abdominal emergencies where presentation is more equivocal and this may lead to improved surgical outcomes.

Keywords: Outcomes, Delay, Emergency, Surgery, Elderly

Core tip: Emergency surgery in elderly is regarded as a subject matter with growing interest as many countries are faced with an ever increasing aging population. The unique and varied characteristics of the elderly make surgical decisions and management an evolving conundrum and challenge. In this paper, we will discuss the outcomes of elderly patients undergoing emergency surgery in our institution, dwell deeper in possible factors that lead to surgical delay and also look into the relationships between surgical delay and surgical outcomes.