The impact of comorbidities and functional status on outcomes in the older adult emergency general surgery patient

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-08-15 DOI:10.1016/j.amjsurg.2024.115903

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引用次数: 0

Abstract

Background

The aim of this study is to quantify the relative contribution of comorbidities and pre-operative functional status on outcomes in geriatric emergency general surgery (EGS) patients.

Methods

This is a retrospective study of older-adult EGS patients at an academic medical center between 2017 and 2018. Patients ≥65 years were included. The primary outcomes examined were 30-day mortality, 30-day morbidity, and length of stay (LOS).

Results

734 patients were included. The mean age was 76, and 48.9 % received non-operative management. The median LOS was 6.8 days; 11.8 % of patients died within 30 days, and 40.6 % developed morbidities. Lacking capacity to consent on admission was independently associated with 30-day mortality (OR: 2.63, [1.32–5.25], p = 0.006). Comorbidities associated with developing morbidity were CVA with neurologic deficit (OR: 2.29, [1.20–4.36], p = 0.012), CHF (OR: 2.60, [1.64–4.11], p < 0.001), in addition to pre-operative delirium (OR: 3.42, [1.43–8.14], p = 0.006).

Conclusions

A significant contribution to outcomes is determined by pre-admission comorbidities and cognitive and functional status. Opportunities exist for collaboration between Acute Care Surgery and geriatric medicine teams for the optimization of comorbidities.

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合并症和功能状态对老年普外科急诊患者预后的影响

背景本研究的目的是量化合并症和术前功能状态对老年急诊普外科（EGS）患者预后的相对贡献。方法这是一项回顾性研究，研究对象是一家学术医疗中心 2017 年至 2018 年间的老年 EGS 患者。研究纳入了年龄≥65 岁的患者。研究的主要结果是 30 天死亡率、30 天发病率和住院时间（LOS）。平均年龄为 76 岁，48.9% 的患者接受了非手术治疗。住院时间中位数为 6.8 天；11.8% 的患者在 30 天内死亡，40.6% 的患者发病。入院时缺乏同意能力与 30 天内的死亡率密切相关（OR：2.63，[1.32-5.25]，P = 0.006）。除术前谵妄（OR：3.42，[1.43-8.14]，p = 0.006）外，与发病率相关的合并症还有CVA伴神经功能缺损（OR：2.29，[1.20-4.36]，p = 0.012）、CHF（OR：2.60，[1.64-4.11]，p <0.001）。急诊外科和老年医学团队之间存在合作机会，以优化合并症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.