Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: A single center experience

Table 1 Distribution of cases according to diagnosis (n = 144)

Indications	Patients, n (%)	Mortality1, n (%)	Morbidity2 (Clavien Dindo 3 and above)
Strangulated hernia
Inguinal	3 (2.0)	0 (0)	0 (0)
Obturator	2 (1.4)	0 (0)	0 (0)
Periumbilical	1 (0.7)	0 (0)	0 (0)
Hollow viscus perforation
Esophagus	1 (0.7)	0 (0)	0 (0)
Gastric ulcer	39 (27.0)	5 (12.8)	7 (17.9)
Duodenal ulcer	13 (9.0)	0 (0)	3 (23)
Gallbladder	2 (1.4)	0 (0)	0 (0)
Small bowel	12 (8.3)	0 (0)	2 (16.7)
Colonic malignancy	8 (5.6)	3 (37.5)	3 (37.5)
Colonic diverticulitis	6 (4.2)	1 (16.7)	1 (16.7)
Appendix	37 (25.7)	0 (0)	0 (0)
Gangrenous viscu
Small bowel gangrene	10 (6.9)	4 (40)	4 (40)
Large bowel gangrene	3 (2.0)	0 (0)	0 (0)
Empyema gallbladder	7 (4.8)	0 (0)	0 (0)

¹Overall mortality n = 13 (9%);

²Overall patients with severe morbidty (Clavien Dindo 3 and above) n = 20 (13.8%).

Table 2 Outcomes after emergency abdominal surgery

Outcome	Patients (n = 144)	(%)
Surgical
Post op ileus	11	7.6
Wound infection	13	9
Abdominal abscess	4	2.7
Anastomotic leak	4	2.7
Post op bleeding	2	1.4
Medical
Respiratory complication	32	22.2
Cardiac complication	20	13.8
Renal complication	12	8.3
Cerebrovascular complication	1	0.7
Thromboembolic complication	5	3.5
Others	6	4.2
Return to OR
Post op bleeding	2	1.4
Anastomotic leak	4	2.7
Anastomotic stenosis	1	0.7
Abdominal collection	1	0.7
Others	1	0.7

Table 3 Stratified time to surgery against morbidity and mortality

		Stratified by time to surgery				Total	P value
		1-6 h	6-12 h	13-24 h	> 24 h
Clavien 2 and below		32	56	25	11	124
Clavien 3 and above		7	5	1	7	20
% of total		17.9%	8.2%	3.8%	38.9%	13.9%	0.003a
Total		39	61	26	18	144
Mortality	No	34	58	24	15	131
	Yes	5	3	2	3	13
% of total		12.8%	4.9%	7.7%	16.7%	9%	0.351
Total		39	61	26	18	144

^aP < 0.05 statistically significant difference between groups.

Table 4 Multivariate analysis of factors associated with Clavien Dindo grade 3 and above complications

Factors	Odds ratio	95%CI	P value
Surgical delay > 24 h	12.75	1.19-136.57	0.035a
Surgical delay > 12 h	0.45	0.05-3.89	0.467
ASA score ≥ 3	0.53	0.16-1.68	0.278
Diabetes mellitus	1.97	0.56-6.87	0.288
Comorbidity index score ≥ 4	0.64	0.06-7.27	0.716
Bedbound patients	1.53	0.09-25.43	0.765

^aP < 0.05 statistically significant difference between groups. ASA: American Society of Anesthesiologists.

Table 5 Multivariate analysis of predisposing factors associated with surgical delay > 24 h

Predisposing factors	Odds ratio	95%CI	P value
ASA score ≥ 3	2.66	0.77-9.26	0.123
Comorbidity index score ≥ 4	1.29	0.19-8.57	0.787
Diabetes mellitus	4.08	1.32-12.55	0.014a
Bedbound patients	0.54	0.02-18.32	0.73
Cognitive impairment	0.45	0.03-6.63	0.566
Chronic analgesia	0.26	0.03-2.33	0.23
Anticoagulants	0.71	0.15-3.36	0.669
Nursing home resident	5.57	0.31-100.25	0.244

^aP < 0.05 statistically significant difference between groups. ASA: American Society of Anesthesiologists.

Table 6 Mean time taken to perform computed tomography against morbidity and mortality

		n	Mean time taken to perform CTAP	Standard error mean	P value
Clavien 2 and below		19	6.5 h	3.436	0.006a
Clavien 3 and above		101	13.1 h	0.776
Mortality	Yes	12	11.667	4.962	0.119
	No	108	7.139	0.797

^aP < 0.05 statistically significant difference between groups. CTAP: Computed tomography scans of the abdomen and pelvis.