Never giving up: outcomes and presentation of emergency general surgery in geriatric octogenarian and nonagenarian patients - 28/07/16
Abstract |
Background |
Aging of the population necessitates consideration of the increasing number of older adults requiring emergency care. The objective of this study was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery (EGS) patients with younger adults.
Methods |
Based on a standardized definition of EGS, patients in the 2007 to 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample were queried for primary EGS diagnoses. Included patients were categorized into older (≥80 years) vs younger (<80 years) adults based on a marked increase in mortality around aged 80 years. Using propensity scores, risk-adjusted differences in major morbidity, mortality, length of stay (LOS), and cost were compared.
Results |
Of 3,707,465 included patients, 17.2% (n = 637,588) were ≥80 years. Relative to younger adults, older patients most frequently presented for gastrointestinal-bleeding (odds ratio [95% confidence intervals]: 2.81 [2.79 to 2.82]) and gastrostomy care (2.46 [2.39 to 2.53]). Despite higher odds of mortality (1.67 [1.63 to 1.69]), older adults exhibited lower risk-adjusted odds of morbidity (.87 [.86 to .88]), shorter LOS (4.50 vs 5.14 days), and lower total hospital costs ($10,700 vs $12,500).
Conclusions |
Octogenarian and/or nonagenarian patients present differently than younger adults. Reductions in complications, LOS, and cost among surviving older adults allude to a “survivorship tendency” to never give up, despite collectively higher mortality risk.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The objective was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery patients with younger adults. |
• | Older patients present differently than younger adults. |
• | Reductions in complications, length of stay, and cost among surviving older adults allude to a “survivorship tendency” to never give up, despite collectively higher mortality risk. |
Keywords : Emergency general surgery, Octogenarian, Nonagenarian, Geriatric, Outcomes
Plan
| A.H.H. is the primary investigator of a contract from the Patient-Centered Outcomes Research Institute (PCORI) entitled “Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the Emergency Department” and a Harvard Surgery Affinity Research Collaborative (ARC) program grant entitled “Mitigating Disparities through Enhancing Surgeons' Ability to Provide Culturally Relevant Care.” A.H.H. is also a cofounder and equity holder of the company Patient Doctor Technologies, Inc., which owns and operates the website www.doctella.com. The remaining authors declare that we have no conflicts of interest or sources of funding relevant to the article to declare. |
Vol 212 - N° 2
P. 211 - août 2016 Retour au numéro
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