Geriatric emergency general surgery: Survival and outcomes in a low-middle income country

• Published in: Surgery Vol. 158; no. 2; pp. 562 - 569
• Main Authors: Shah, Adil A., MD, Haider, Adil H., MD, MPH, FACS, Riviello, Robert, MD, MPH, FACS, Zogg, Cheryl K., MSPH, MHS, Zafar, Syed Nabeel, MD, MPH, Latif, Asad, MD, MPH, Rios Diaz, Arturo J., MD, Rehman, Zia, MBBS, FCPS, Zafar, Hasnain, MBBS, FRCS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2015
• Subjects: Age Factors; Aged; Aged, 80 and over; Developing Countries; Emergencies; Female; General Surgery; Humans; Length of Stay - statistics & numerical data; Male; Multivariate Analysis; Odds Ratio; Outcome Assessment, Health Care; Pakistan; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Propensity Score; Risk Factors; Surgery; Surgical Procedures, Operative - mortality; Pakistan
• ISSN: 0039-6060; 1532-7361; 1532-7361
• DOI: 10.1016/j.surg.2015.03.045

Background Geriatric patients remain largely unstudied in low-middle income health care settings. The purpose of this study was to compare the epidemiology and outcomes of older versus younger adults with emergency general surgical conditions in South Asia. Methods Discharge data from March 2009 to April 2014 were obtained for all adult patients (≥16 years) with an International Classification of Diseases, 9th revision, Clinical Modification diagnosis codes consistent with an emergency general surgery condition as defined by the American Association for the Surgery of Trauma. Multivariable regression analyses compared patients >65 years of age with patients ≤65 years for differences in all-cause mortality, major complications, and duration of hospital stay. Models were adjusted for potential confounding owing to patient demographic and clinical case-mix data with propensity scores. Results We included 13,893 patients; patients >65 years constituted 15% ( n  = 2,123) of the cohort. Relative to younger patients, older adults were more likely to present with a number of emergency general surgery conditions, including gastrointestinal bleeding (odds ratio OR [95% CI], 2.63[1.99–3.46]), resuscitation (2.17 [1.67–2.80]), and peptic ulcer disease (2.09 [1.40–3.10]). They had an 89% greater risk-adjusted odds (1.89 [1.55–2.29]) of complications and a 63% greater odds (1.63 [1.21–2.20]) of mortality. Restricted to patients undergoing operative interventions, older adults had 95% greater odds (1.95 [1.29–2.94]) of complications and 117% greater odds (2.17 [1.62–2.91]) of mortality. Conclusion Understanding unique needs of geriatric patients is critical to enhancing the management and prioritization of appropriate care in developing settings.