Nonagenarian surgical admissions for the acute abdomen: who benefits?

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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:  Patients 90 years and older form an increasing proportion of the general population. Outcomes of their acute surgical admissions are not well documented. Methods and materials:  Surgical management of 49 consecutive nonagenarian admissions (median age: 92 years) 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:  Nonagenarian group consisted of mainly women (71% vs. 50%; p = 0.003). 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% (n = 2) were operated on. In contrast, 38% (n = 19) of patients aged 50-59 (p = 0.0001) 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; p = 0.04). The very large majority of survivors in both age groups were discharged back to their preadmission domicile [39 (95%) nonagenarians vs. 46 (96%) comparator 50-59 year group]. Conclusions:  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]

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