Published online Sep 27, 2015. doi: 10.4240/wjgs.v7.i9.208
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
Processing time: 159 Days and 11.3 Hours
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.
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.