Nonagenarian surgical admissions for the acute abdomen: who benefits?
Int J Clin Pract. 2010 Oct;64(11):1570-1572
Authors: Toumi Z, Kesterton A, Bhowmick A, Beveridge AJ, Scott NA
Introduction:â€‚ Patients 90â€ƒyears and older form an increasing proportion of the general population. Outcomes of their acute surgical admissions are not well documented. Methods and materials:â€‚ Surgical management of 49 consecutive nonagenarian admissions (median age: 92â€ƒyears) with an acute abdomen was compared with the management and outcome of 50 younger patients (median age: 53.5) admitted with a suspected acute abdomen over the same period. Results:â€‚ Nonagenarian group consisted of mainly women (71% vs. 50%; pâ€ƒ=â€ƒ0.003). The use of laboratory investigations and imaging was similar for the patients aged over 90 and the younger patients, although proportionately fewer nonagenarians were investigated by abdominal CT scan (8% vs. 24%). Of the 49 nonagenarian patients admitted, only 4% (nâ€ƒ=â€ƒ2) were operated on. In contrast, 38% (nâ€ƒ=â€ƒ19) of patients aged 50-59 (pâ€ƒ=â€ƒ0.0001) underwent a surgical intervention. A much greater proportion of nonagenarians died in hospital than patients in the 50-59 comparator group (16% nonagenarians vs. 4% comparator patients; pâ€ƒ=â€ƒ0.04). The very large majority of survivors in both age groups were discharged back to their preadmission domicile [39 (95%) nonagenarians vs. 46 (96%) comparator 50-59â€ƒyear group]. Conclusions:â€‚ In this study, when compared with younger patients, very few nonagenarian patients (2%) with a suspected acute abdomen benefited from surgical admission. Instead, the large majority of nonagenarians either died or were discharged back to their home address without surgery.
PMID: 20846205 [PubMed - as supplied by publisher]