Emergency laparotomy in older patients may lead to worse morbidity, mortality

Morbidity and mortality following emergency laparotomy appear to be worse in elderly patients than in those who are relatively younger, and this may be attributed to comorbidities resulting in higher American Society of Anaesthesiology (ASA) physical status classification, a study has shown.

The analysis included 170 emergency laparotomies performed in patients from the National University Hospital, Singapore. Researchers collected demographic data, indication of surgery and surgical procedure. They also evaluated nutritional scores.

Elderly patients had a significantly longer mean stay in hospital (31.5 vs 18.6 days; p=0.006) and mean stay in ICU (13.1 vs 5.3 days; p=0.003) compared with nonelderly patients. Furthermore, elderly patients were more likely to develop postlaparotomy complications (65.8 percent vs. 37.4 percent, p<0.001).

Mortality was also less favourable for elderly vs nonelderly patients, both at 30 days (31.5 percent vs 8.8 percent; p=0.019) and 1 year (27.9 percent vs 14.3 percent; p=0.023).

There were no significant between-group differences observed in the global 3-Minute Nutrition Screening tool and the global subjective global assessment nutritional scores.

ASA status emerged as a significant risk factor for lower survival following emergency laparotomy (hazard ratio [HR], 2.61, 95 percent confidence interval [CI], 1.05–6.45; p=0.038). On univariate analysis, age ≥65 years correlated significantly with survival (HR, 1.03, 95 percent CI, 1.01–1.05; p=0.003), but this effect disappeared following multivariate regression (HR, 1.01, 95 percent CI, 0.453–2.23; p=0.989).